Chronic Splenic Q Fever?

Abstract

tine hypercaptation associated with mesenteric lymph nodes and a right sub-clavicular lymph node (Figure 1). The splenic lesions had been confirmed by abdominal magnetic resonance imaging (MRI) (Figure 2). Colonoscopy showed inflammatory polipoyd lesions of the distal small intestine and uncomplicated diverticular colic disease. Gastroscopy, pulmonary scan, transesophageal echocardiography and bone marrow biopsy showed negatives. Doxycycline 200 mg b.i.d. and rifampicine 600 mg daily for three months treatment was initiated. In the absence of any improvement, after adequate vaccination for meningococcus, pneumococcus and haemophilus, splenectomy was carried out. The histopathological examination highlighted diffuse granulo-A 53-year-old man, with history of paranoid schizophrenia, depression, alcohol abuse, type 2 diabetes mellitus, comes to our observation for the discovery of focal splenic lesions. He presented fatigue and weight loss. Her past clinical history was negative for infection, abdominal pain, fever or sweat. Physical examination was characterized by cachexia in the absence of lymphadenomegaly and hepatosplenomegaly. Laboratory tests were negative, except for the C. burnetii antibodies (phase I IgG 1/128, phase II IgG 1/400 and negative IgM). Biological liver and kidney function were normal. Hepatitis B, hepatitis C, HIV, EBV, CMV serology were negatives. Positron emission tomography (PET) showed more hypermetabolic splenic lesions, distal small intes-