Q fever endocarditis masquerading as Mixed cryoglobulinemia type II. A case report and review of the literature

BMC Infectious Diseases
Petros I RafailidisChristos A Fourlas

Abstract

The clinical manifestations of Q fever endocarditis are protean in nature. Mixed cryoglobulinemia type II is rarely a facet of the presenting clinical manifestations of Q fever endocarditis. We report a case of a 65-year-old pensioner with such an association and review the literature. As transesophageal echocardiograms are usually normal and blood cultures are usually negative in Q fever endocarditis, many of the manifestations (fever, rash, glomerulonephritis/evidence of renal disease, low serum C4 complement component, presence of mixed type II cryoglobulin, constitutional symptoms as arthralgias and fatigue) can be attributed to Mixed cryoglobulinemia type II per se. The use of Classic Duke Endocarditis Service criteria does not always suffice for the diagnosis of Q fever. The application of the modified criteria proposed by Fournier et al for the improvement of the diagnosis of Q fever endocarditis will help to reach the diagnosis earlier and thus reduce the high mortality of the disease. We would like to stress the importance of ruling out the diagnosis of Q fever endocarditis in cases of mixed type II cryoglobulinemia.

References

Sep 1, 1992·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·T J MarrieP Durnford
Mar 1, 1989·Annals of the Rheumatic Diseases·H TorleyC McCartney
Jul 1, 1988·Archives of Internal Medicine·B I LevE Rubinstein
Apr 1, 1995·European Heart Journal·A Stein, D Raoult
Mar 8, 1993·Archives of Internal Medicine·P BrouquiA Bertrand
Jan 1, 1996·American Journal of Nephrology·H Vacher-CoponatY Berland
Jan 1, 1997·Scandinavian Journal of Infectious Diseases·Y Siegman-IgraI Shalit
Jun 1, 1997·Mayo Clinic Proceedings·E F BerbariJ M Steckelberg
Aug 18, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·M GhassemiG B Howe
Oct 27, 1999·Journal of the American Academy of Dermatology·B GranelP J Weiller
Mar 18, 2000·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·J V GrahamA W Karchmer

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Citations

Nov 20, 2016·Clinical Microbiology Reviews·Carole EldinDidier Raoult
Feb 17, 2017·Journal of Investigative Medicine High Impact Case Reports·Kellie L HawkinsRobert W Janson
Dec 12, 2020·KI Reports·Simon LeclercLouis-Philippe Laurin
Oct 31, 2020·Curēus·Kevin Liu, Andrew Newman
Sep 10, 2021·Rheumatology·Maxime BeydonUNKNOWN French Vasculitis Study Group (FVSG)

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Methods Mentioned

BETA
ELISA
ESR
electrophoresis
PCR
biopsy

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