Korean J Pathol.  2012 Feb;46(1):10-14. 10.4132/KoreanJPathol.2012.46.1.10.

Clinicopathologic Features of Q Fever Patients with Acute Hepatitis

• Lee M
• Jang JJ
• Kim YS
• Lee SO
• Choi SH
• Kim SH
• Yu E

• KMID: 1439768
• DOI: http://doi.org/10.4132/KoreanJPathol.2012.46.1.10

Abstract

BACKGROUND
Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described.
METHODS
Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests.
RESULTS
All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure.
CONCLUSIONS
C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.

Keyword

Coxiella burnetii; Q fever; Hepatitis; Liver biopsy; Granuloma

MeSH Terms

Anti-Bacterial Agents
Biopsy
Cholangitis
Coxiella burnetii
Eosinophils
Fever
Fibrin
Granuloma
Hepatitis
Humans
Hyperbilirubinemia
Liver
Q Fever
Anti-Bacterial Agents
Fibrin