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• W2912986197 abstract "A 43 year old male presented with a two week history of severe myalgias, headache, jaundice, fever, and abdominal pain which began after returning to the US from his 7th military tour in Afghanistan. Initial labs at an outside hospital were notable for a direct hyperbilirubinemia, prompting transfer to our tertiary care center for ERCP. He was noncompliant with his doxycycline for anti-malarial prophylaxis. He denied exposure to contaminated water or ticks but had eaten local cuisine including goat liver. On physical exam he was febrile to 102.5 degrees F, had scleral icterus, conjunctival suffusion, was diffusely jaundice and had hepatosplenomegaly. Pertinent labs: platelets 59,500, total bilirubin 12.4 mg/dL, direct bilirubin 8 mg/dL, AST 41 units/L, ALT 56 units/L, and alkaline phosphatase 138 units/L. Abdominal MRI was unrevealing. Diagnostic testing for CMV, EBV, HIV, syphilis, malaria, Rocky Mountain Spotted Fever, tularemia, ehrlichiosis, chikungunya, leptospirosis, histoplasmosis, tuberculosis, Q fever, and dengue were obtained.He was empirically started on pipercillicin/tazobactam and doxycycline. Ten days into his admission the Coxiella burnetii DNA PCR returned positive, thus confirming Q fever. Despite optimum therapy on doxycyline, he did not defervesce until 14 days into his hospital course. At follow up two weeks later, he remained afebrile and his total bilirubin had normalized to 0.9 mg/dL (peak of 13.7 mg/dL). Coxiella burnetti has been rarely known to present with hepatitis with or without hyperbilirubinemia in the acute setting. However, what makes our case unique is the degree of isolated direct hyperbilirubinemia in the setting of only mildly elevated transaminases. There was a retrospective study in Taiwan by Chang et al in 2008 which describes 103 patients with Q fever, 88 of whom presented with acute hepatitis. In addition to hepatitis, 36% of these patients presented with hyperbilirubinemia. However, only 3 of these patients presented with a total bilirubin greater than 5 mg/dL. Fever duration despite appropriate pharmacologic therapy was found to be prolonged in patients with hyperbilirubinemia versus those without (11.5 days versus 5 days). Also, it seems that thrombocytopenia was only observed in 12.6% of the patients. Given this clinical picture, it is important to consider Q fever for a direct hyperbilirubinemia, prolonged fever, and thrombocytopenia in patients with a potential exposure." @default.
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• W2912986197 date "2017-10-01" @default.
• W2912986197 modified "2023-09-24" @default.
• W2912986197 title "Cholestatic Jaundice: A Rare Presentation of Coxiella burnetii" @default.
• W2912986197 doi "https://doi.org/10.14309/00000434-201710001-02157" @default.
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