A24 FEVER, CHOLESTATIC HEPATITIS & PNEUMONIA, A COMMON PRESENTATION OF AN UNCOMMON DISEASE: CASE REPORT & LITERATURE REVIEW

Q fever is a zoonotic infection caused by Coxiella burnetii and usually acquired by susceptible patients with common risk factors. The diagnosis is usually delayed. Known manifestations of it include fever of unknown origin, endocarditis, atypical pneumonia, and hepatitis. To describe an interesting case of Q fever and review the literature on Q fever and its hepatic manifestations. Patient’s informations were extracted from electronic records and included admission notes, laboratory investigations, procedure reports, pathology notes, and clinic reports. In addition, we performed a literature review using pubmed. We are reporting a case of a 48 years old male with no recognizable risk factor who presented with fever, pneumonia, cholestatic hepatitis, anasarca, and coagulopathy. He did not improve with empiric antibiotic treatment. He had an extensive negative workup and definitive diagnosis was only made after the results of a of liver biopsy showed Q fever’s typical finding of a fibrin ring granuloma. He was started on treatment with an 18 month course of doxycycline resulting in full recovery. Reports from different geographical locations indicate that epidemiological and clinical features of Q fever vary from area to area with most cases presenting as hepatitis being in Europe and more specifically in Spain. North American data showed an increasing number of Q fever cases being reported to the CDC from 19 cases reported in 2000 to 176 cases in 2014. In Canada, the national incidence is not known, but it is notifiable disease in some provinces with a a total of 47 confirmed Q fever cases being reported in Ontario from 2006 to 2011 with a four-fold increase in cases in 2011. Seasonal variation in incidence has been observed. In addition to the fever and other symptoms, a number of hepatic manifestations of Q fever have been described including mild to moderate transaminitis (which is the most common hepatic presentation), cholestatic hepatitis, granulomatous hepatitis, hepatic abscess, triggering of autoimmune hepatitis/primary biliary cholangitis overlap by Q fever, and acute acalculous cholecystitis. The incidence of Q fever is increasing in North America with a wide spectrum of presenting clinical symptoms. In the presence of atypical hepatitis with exclusion of other causes, investigations should be conducted to rule out Q fever. Fibrin ring granuloma on liver biopsy (high power) None

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