Delayed Diagnosis of Chronic Q Fever and Cardiac Surgery
Delayed Diagnosis of Chronic Q Fever and Cardiac Surgery
A 78-year-old man had a medical history of aortic valve stenosis of a tricuspid valve, abdominal aortic aneurysm, and endovascular aneurysm repair in 2005. In July 2011, he was screened for chronic Q fever in a program for patients at high risk for development of chronic Q fever (e.g., persons with a vascular prosthesis or aneurysm); the screening revealed that he did have chronic Q fever infection (Table). The patient had not been aware of an acute Q fever episode and did not report night sweats, weight loss, malaise, or fever. Because the he had progressive aortic valve stenosis, the patient was on a waiting list for elective valve replacement at an academic cardiovascular center. This center, located outside the Q fever epidemic area and unaware of the patient's Q fever status, placed a bioprosthesis in the patient in August 2011. The native valve was not further examined because there were no macroscopic signs of endocarditis.
After the surgery, the Q fever screening results were acted upon. FDG PET/CT scan results showed no signs of infection at the abdominal aortic prosthesis or elsewhere. In September 2011, the patient started antimicrobial drug therapy (doxycycline and hydroxychloroquine) and was doing well at a 6-month follow-up visit.
Case 2
A 78-year-old man had a medical history of aortic valve stenosis of a tricuspid valve, abdominal aortic aneurysm, and endovascular aneurysm repair in 2005. In July 2011, he was screened for chronic Q fever in a program for patients at high risk for development of chronic Q fever (e.g., persons with a vascular prosthesis or aneurysm); the screening revealed that he did have chronic Q fever infection (Table). The patient had not been aware of an acute Q fever episode and did not report night sweats, weight loss, malaise, or fever. Because the he had progressive aortic valve stenosis, the patient was on a waiting list for elective valve replacement at an academic cardiovascular center. This center, located outside the Q fever epidemic area and unaware of the patient's Q fever status, placed a bioprosthesis in the patient in August 2011. The native valve was not further examined because there were no macroscopic signs of endocarditis.
After the surgery, the Q fever screening results were acted upon. FDG PET/CT scan results showed no signs of infection at the abdominal aortic prosthesis or elsewhere. In September 2011, the patient started antimicrobial drug therapy (doxycycline and hydroxychloroquine) and was doing well at a 6-month follow-up visit.
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