Goyal A, Dalia T, Bhyan P, Farhoud H, Shah Z, Vidic A. Rare case of chronic Q fever myocarditis in end stage heart failure patient: A case report. World J Cardiol 2022; 14(9): 508-513 [PMID: 36187426 DOI: 10.4330/wjc.v14.i9.508]
Corresponding Author of This Article
Andrija Vidic, DO, Doctor, Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States. avidic@kumc.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Amandeep Goyal, Tarun Dalia, Zubair Shah, Andrija Vidic, Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
Poonam Bhyan, Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC 28304, United States
Hassan Farhoud, School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
Author contributions: Goyal A and Dalia T have contributed equally to the manuscript writing, editing, and data collection; Bhyan P and Farhoud H have assisted with writing and edits; Shah Z and Vidic A have contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrija Vidic, DO, Doctor, Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States. avidic@kumc.edu
Received: May 26, 2022 Peer-review started: May 26, 2022 First decision: June 16, 2022 Revised: June 30, 2022 Accepted: August 16, 2022 Article in press: August 16, 2022 Published online: September 26, 2022 Processing time: 116 Days and 7.6 Hours
Abstract
BACKGROUND
Q fever myocarditis is a rare disease manifestation of Q fever infection caused by Coxiella burnetii. It is associated with significant morbidity and mortality if left untreated. Prior studies have reported myocarditis in patients with acute Q fever. We present the first case of chronic myocarditis in an end-stage heart failure patient with chronic Q fever infection.
CASE SUMMARY
A 69-year-old male was admitted with dyspnea on exertion, hypotension and bilateral lower extremity edema for a few months. He has a past medical history of ischemic cardiomyopathy with left ventricular ejection fraction of 25%, implantable cardioverter defibrillator in place, bioprosthetic aortic valve and mitral valve replacement. He continued to have shortness of breath despite diuresis along with low grade fevers. Initial infectious work up came back negative. On further questioning, the patient was found to have close contact with farm animals and the recurrent fevers prompted the work-up for Q fever. Q fever serologies and cardiac positron emission tomography confirmed the diagnosis of chronic Q fever myocarditis. He was then successfully treated with doxycycline and hydroxychloroquine for 18 mo.
CONCLUSION
Chronic Q fever myocarditis, if left untreated, carries a poor prognosis. It should be kept in differentials, especially in patients with recurrent fevers and contact with farm animals.
Core Tip: Q fever myocarditis is a rare disease (< 1% of cases) caused by infection with Coxiella burnetii (gram-negative proteobacteria). Q fever normally has a pleomorphic and non-specific clinical presentation which leads to delayed diagnosis and treatment, which can lead to worse outcomes. Q fever myocarditis should be kept in differentials not only in patients with acute Q fever but also with chronic Q fever infection, like in our case. Q fever serologies help in making a diagnosis of acute and chronic Q fever. Cardiac positron emission tomography and magnetic resonance imaging can be utilized to diagnose myocarditis in the setting of Q fever. Hydroxychloroquine and doxycycline, in combination, are used for treatment of Q fever myocarditis.
