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• W2980369046 abstract "SESSION TITLE: Pulmonary Pathology SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 01:00 pm - 02:00 pm INTRODUCTION: Q fever is a zoonotic infection caused by the pathogen Coxiella burnetii. Patients can present with a wide spectrum of clinical manifestations. Pulmonary interstitial fibrosis is one of the rare clinical manifestations of Q fever associated conditions. CASE PRESENTATION: 59-year-old man, history of IgA nephropathy and aortic insufficiency status post porcine type aortic valve replacement over 1 year ago who presented with worsening of dyspnea for 2 weeks. He had 4-6 months symptoms with low-grade fever of unknown origin, chills, poor appetite, weight loss, and chronic diarrhea. Physical exam- unremarkable except coarse bilateral inspiratory crackles, more pronounced at both bases posteriorly. Extensive workups as an outpatient including for HIV, connective tissue disease, fungi, viruses were negative. Laboratory findings on admission showed hemoglobin 8.8, WBC count 2.3, and platelet count 88, BUN 43, creatinine 3.2. Chest X ray (CXR) showed bilateral coarse reticular infiltrates. CT of chest without contrast showed Interstitial thickening with ground glass infiltrates in both lungs especially in the lower lungs and carinal lymph node. Bronchoscopy with bronchoalveolar lavage and endobronchial ultrasound and carinal lymph node biopsies were performed. The results were inconclusive. Patient underwent wedge biopsies of right upper and lower lobe of lung. Biopsies revealed interstitial lung disease( ILD), bronchiolitis obliterans organizing pneumonia- like pattern with non-caseating granuloma and areas with honeycomb change. Tissue culture didn’t grow any organism. At the same time, work up was positive for Q fever by serology Ig M Phase I titer >1:256, Ig M Phase II titer >1:128 and IgG Phase II titer >1:64,000. Trans esophageal echocardiogram was negative for vegetation He was started on doxycycline and hydroxychloroquine. Patient was also started on oral prednisone for symptomatic granulomatous ILD. He improved significantly in his breathing and constitutional symptoms. He was on extended course of oral prednisone 20 mg over a year. Repeat CXR after a few months showed improvement of infiltrates. Repeat Q fever IgM serology titers trended down to 1:16 with antibiotics. DISCUSSION: It is challenging to reach diagnosis in ILD and fever of unknown origin. Patients with a vascular prosthesis (eg, cardiac valve, vascular graft) and unexplained fever should be tested for Q fever. Acute infection of Q fever can be diagnosed with serology testing using immunofluorescence assay if the titer of anti-phase II is ≥200 for IgG and ≥50 for IgM. CONCLUSIONS: We report an extremely rare case of granulomatous ILD associated with Q fever. There were few previous case reports of interstitial lung disease associated with Q fever which were successfully treated with antibiotics and corticosteroids. Our patient had good clinical and radiological improvement with oral prednisone and antibiotics. Reference #1: Pérez de Llano L, A, Veres Racamonde A, Rivas Bande M, J, Ortiz Piquer M, Bal Nieves F, Rodríguez Feijoo A: Bronchiolitis obliterans with Organizing Pneumonia Associated with Acute Coxiella burnetii Infection. Respiration 2001;68:425-427. https://doi.org/10.1159/000050541 Reference #2: Hippe, S., Kellner, N., Seliger, G. et al. [Q fever : A rare differential diagnosis of granulomatous disease.)Pathologe (2016) 37: 269. https://doi.org/10.1007/s00292-016-0154-z Reference #3: Melenotte, Cléa, et al. Coxiella burnetii: a hidden pathogen in interstitial lung disease?.” Clinical Infectious Diseases 67.7 (2018): 1120-1124. DISCLOSURES: No relevant relationships by John Gao, source=Web Response No relevant relationships by Phyo Kyaw, source=Web Response No relevant relationships by Faraaz Nayeemuddin, source=Web Response No relevant relationships by Mingchen Song, source=Web Response No relevant relationships by Saad Ullah, source=Web Response" @default.
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• W2980369046 date "2019-10-01" @default.
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• W2980369046 title "A RARE ETIOLOGY OF INTERSTITIAL LUNG DISEASE" @default.
• W2980369046 doi "https://doi.org/10.1016/j.chest.2019.08.839" @default.
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