Myocarditis, a rare but severe manifestation of Q fever: Report of 8 casesand review of the literature

Myocarditis has only rarely been described as a manifestation of acute Q fe ver. Among our series of 1276 patients in whom acute Q fever was diagnosed during 1985-1999, myocarditis was diagnosed in 8. Two patients (25.0%) deve loped cardiac symptoms during the course of interstitial pneumonia, 2 (25.0 %) initially presented with unexplained fever, and 1 (12.5%) presented with febrile cutaneous rash. In 3 patients, cardiac symptoms were inaugural: 1 patient experienced heart failure, and 2 experienced precordial pain. Dilat ed cardiomyopathy was documented in 7 patients, and 2 (1 of whom had underg one heart transplantation) died despite therapy. In addition, 1 patient was scheduled for heart transplantation because of cardiac insufficiency. When the patients in this study were compared with 32 control patients with acu te Q fever, no specific epidemiological or clinical features were associate d with this disease except worse prognosis (P = .006). Moreover, among the 12 patients from our series who died as a result of acute Q fever, 2 patien ts, who were significantly younger than the other 9 patients (P = .03), had myocarditis. Our study highlights the severity of Coxiella burnetii myocar ditis.