Infect Chemother IC Infection and Chemotherapy 1598-8112 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy 10.3947/ic.2009.41.3.199 Case Report Two Cases of Q Fever Endocarditis Moon Soo-youn M.D. 1 Choi Yong Sill 2 Park Mi-Yeoun 2 Lee Jung A M.D. 1 Chung Mi Kyung M.D. 1 Chung Hye Suk M.D. 1 Jung Doo Ryoun M.D. 1 Song Jae Hoon M.D. 1 Peck Kyong Ran M.D. 1 Division of infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Division of Zoonoses, Center for Immunology & Pathology, Korean National Institute for Health, Korean Center for Disease Control and Prevention, Seoul, Korea. Correspondence author: Kyong Ran Peck, M.D. Division of infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 50 Ilwon-don, Kangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-0329, Fax: +82-2-3410-0041, krpeck@skku.edu May-Jun 2009 30 06 2009 41 3 199 204 25 02 2009 01 04 2009 Copyright © 2009 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy 2009

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Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.

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Transesophageal echocardiography of case-1 shows severe calcification of aortic valve.

Liver biopsy of case-1 shows multifocal lymphocyte infiltration, moderate inflammation, and multifocal spotty hepatic necrosis (H & E stain, ×200).

PCR for C. burnetii. A) Case-1 : 1-blood sample on May 3, 2007, 2-blood sample on May 22, 2008 and case 2, B) Case-2 : 1 and 2-blood sample on Jan. 22, 2008, 3-blood sample on Nov. 26, 2008, 4-blood sample on Dec. 3, 2008, 5-tissue from valve surgery. M: marker, P: positive control with DNA for C. burnetii, N: negative control.

Q Fever Antibody Titers in Case-1 and Case 2