Mononeuritis multiplex caused by Coxiella burnetii infection (Q fever)

Abstract

After 1 week of flu-like illness, a 64-year-old man developed rapidly progressive mononeuritis multiplex involving the right arm and both legs. Serologic studies identified Coxiella burnetii as the cause of the febrile disease (Q fever). Fourteen days doxycycline treatment (200 mg daily) induced rapid and complete recovery. After 6 months, flu-like symptoms, weakness and hypalgesia of the right leg reappeared. Antibody titers again identified Q fever. Doxycycline was re-established and induced prompt recovery. Q fever has been associated with various neurologic complications such as meningoencephalitis, cerebellitis, optic neuritis or polyneuroradiculitis. This is the first report on Q fever related mononeuritis multiplex. Prolonged antibiotic treatment may be required to prevent relapsing infection from the resistant bacterium.

Is Q Fever an emerging or re-emerging zoonosis?

“…IV) and on retrospective studies of isolated cases or on uncommon clinical manifestations (meningitis and neurological manifestations [14,29,84,111,119,120,137,146], myocarditis [45,106,108], lymphadenitis [6,161], bone marrow granulomatosis [24,128] and pancreatitis [154]) has been growing since 1999. However this increase may only reflect a higher awareness of the disease rather than really its emergence.…”

Optic neuritis associated with Q fever: case report and literature review

“…[3][4][5] Aseptic meningitis, encephalitis, encephalomyelitis, peripheral neuropathy, Guillain-Barré syndrome, Miller-Fisher syndrome, and mononeuritis multiplex have all been described. 4,6 It is thought that nervous system involvement results from hematogenous spread following microbial acquisition by inhalation. 3 However, the mechanism in the case of optic neuritis may be an autoimmune, post-infectious phenomenon (see below).…”

Brachial plexopathy associated with Q fever: Case report and review of the literature

“…A handful of other reported cases of peripheral nervous system complications of Q fever include three cases each of Guillain–Barré syndrome1–3 and peripheral neuropathy,3, 23, 24 one case each of mononeuritis multiplex28 and brachial neuritis,18 and one case each of possible lumbar neuritis34 and neuritis 13. Only two patients had peripheral nerve involvement documented by electrophysiological studies 18, 28…”

“…The findings of electrodiagnostic tests were consistent with brachial plexopathy (neuritis), and treatment with oral doxycycline proved successful. Sommer et al28 reported a 64‐year‐old man with a febrile illness followed by weakness in the right arm and both legs. The resulting diagnosis of mononeuritis multiplex was based on clinical and neurophysiologic findings of dysfunction in both femoral nerves and in the right axillary, musculocutaneous, radial, and sciatic nerves.…”