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Lee, Kim, Yoon, Lee, Yeon, Byun, Kim, and Ryu: Q Fever as a Cause of Acute Hepatitis Accompanying Fever
Case Report

Korean J Gastroenterol 2011;57(3):189-193.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.3.189

Q Fever as a Cause of Acute Hepatitis Accompanying Fever

Hyun Jung Lee, Ji Hoon Kim, Eileen L. Yoon, Young Sun Lee, Jong Eun Yeon, Kwan Soo Byun, Baek-Hui Kim1, Youngjoon Ryu1

Department of Internal Medicine, Korea University of Medical College, Seoul, Korea

1Department of Pathology, Korea University of Medical College, Seoul, Korea

Correspondence to: Ji Hoon Kim, Department of Internal Medicine, Korea University College of Medicine, 97, Gurodong gil, Guro-dong, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3011, Fax: +82-2-2626-1038, E-mail: kjhhepar@naver.com

Received 28 August 2010       Revised 11 October 2010       Accepted 11 October 2010

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Q fever is a zoonotic infection caused by Coxiella burnetti, which has been previously regarded as an uncommon infectious disease in Korea but is sporadically reported recently. Common manifestations of acute Q fever usually present as influenza-like illness, pneumonia and occasionally hepatitis. Herein, we report 4 cases of acute Q fever as a cause of acute hepatitis and fever. All patients had fever and non-specific symptoms, and laboratory test showed acute hepatitis. Antibody surveys for many virus infections and bacterial cultures were negative. Finally, they were diagnosed acute Q fever by an indirect micro-immunofluorescence test. Liver biopsy in 3 patients revealed granuloma including one with typical fibrin-ring. All patients had complete resolution of symptoms and signs with doxycycline treatment. Q fever should be considered in the differential diagnosis of patients with fever of unknown origin with acute hepatitis in Korea.

Keywords: Q fever, Coxiella burnetti, Hepatitis, Granuloma

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Fig. 1.
A liver biosy specimen of case 1 (H&E stain, ×400). A lipid granuloma with a fibrinoid ring (arrow) within the inflammatory focus, and small vague granuloma were noted.
kjg-57-189f1.tif
Fig. 2.
A liver biosy specimen of case 2 (H&E stain, ×400). A granuloma composed of mixture of elongated epithelioid cells, histiocytes, and lymphocytes were noted.
kjg-57-189f2.tif
Table 1.
Characteristics of Four Patients with Acute Q Fever
  Case 1 Case 2 Case 3 Case 4
Age (years)/gender 44/M 54/M 49/M 51/M
Domicile Gimpo Dangjin Incheon Seoul
Occupation Public servant Farmer Officer Unemployed
History of animal contact None None None None
Duration of fever 3 weeks 4 weeks 2.5 weeks 4 weeks
Associated symptoms Chills, headache, abdominal discomfort Anorexia, epigastric discomfort Chills, myalgia Anorexia, myalgia, weight loss
Organomegaly Hepatosplenomegaly Hepatosplenomegaly Hepatomegaly Hepatosplenomegaly
IFA (IgG/IgM) [maximum] 1：2,048/1：512 1：2,048/1：256 1：2,048/1：512 1：2,048/1：2,048
Bilirubin (mg/dL) [initial/peak] 2.09/2.09 1.2/1.2 1.5/1.5 3.15/3.15
AST (IU/L) [initial/peak] 130/130 109/130 73/73 47/124
ALT (IU/L) [initial/peak] 38/38 111/156 104/104 6/11
WBC count (L/m3) [initial] 8,200 8,000 7,400 18,800
Liver biopsy Fibrin-ring granuloma Non-caseating granuloma Non-caseating granuloma Not done
Bone marrow biopsy Not done Not done Not done Normal
Defervescence after effective therapy (days) 1 2 4 1
Therapy Doxycycline for 2 weeks Doxycycline, rifampin for 2 weeks Doxycycline, rifampin for 2 weeks Doxycycline for 2 weeks
Date of diagnosis 2007. 11. 16. 2008. 2. 15. 2008. 3. 18. 2006. 9. 19.

IFA, immunofluorecence assay.

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