SHM Converge Scientific Abstract ePoster Gallery-Hepatic Q Fever: Investigating a Puzzling Liver Injury

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This case report describes a 52-year-old man with two weeks of nausea, vomiting, fatigue, myalgias, abdominal distension, jaundice, and right upper quadrant pain. Initial workup suggested acute cholecystitis or cholangitis because ultrasound showed gallbladder wall thickening and gallstones, and he had fever, jaundice, and RUQ pain. However, his overall picture did not fit a typical biliary infection: he had marked hepatomegaly, mixed hepatocellular-cholestatic liver injury, elevated INR and bilirubin, no leukocytosis, and persistently negative studies for hepatitis, EBV, CMV, blood cultures, and autoimmune disease. Imaging and HIDA scan ultimately did not support cholecystitis or cholangitis.<br /><br />Because of persistent fevers despite ceftriaxone and metronidazole, clinicians broadened the differential to include hepatic Q fever, a form of Coxiella burnetii infection that can present with nonspecific fever, malaise, and liver dysfunction. Although the patient denied classic exposure to farm animals, recent travel, or new sexual partners, his work as a fast-food restaurant manager raised the possibility of exposure to contaminated food products or unpasteurized dairy. Doxycycline was started on hospital day 5, after which fevers resolved quickly and liver tests gradually improved. Q fever serology later returned positive. He was discharged on oral doxycycline and ultimately required a four-week course for full resolution of transaminitis.<br /><br />The report emphasizes three main points: Q fever is becoming more common in the U.S. and should be considered in unexplained abdominal or hepatic illness; exposure history may be atypical; and doxycycline is the treatment of choice for suspected or confirmed Q fever.

Asset Subtitle

Ryan Murphy

Meta Tag

Author List Ayesha Singh, Ryan Murphy, Stephanie Zia

Category Clinical Vignettes

Concept Q fever

Concept Doxycycline

Concept Fever

Concept Hepatic Disease

Concept Biliary Disease

Distinguished Non-Finalist

Presenter Organization Keck School of Medicine of USC

Presenting Author Ryan Murphy

Track Adult

Keywords

Q fever

Coxiella burnetii

hepatitis

jaundice

right upper quadrant pain

hepatomegaly

doxycycline

transaminitis

cholecystitis differential

fever

Q fever

Doxycycline

Fever

Hepatic Disease

Biliary Disease