title: [Sheep, chills and "doughnut granuloma"--an atypical course of Coxiella infection].
abstract: Q fever usually presents with high fever, headache and an atypical pneumonia. A case report of a 47-year-old patient with an atypical course of a coxiella infection is described. The dominant clinical symptoms were a liver and bone marrow involvement, whereas pulmonary manifestations were absent. The diagnosis of Q fever in this patient was based on the detection of cytoplasmatic inclusion bodies in macrophages and granulocytes. Furthermore fibrin-ring granulomas ("doughnut lesions") were found in liver tissue specimen and epitheloid-cell granulomas were detected in bone marrow specimen. Complement-fixation antibody titers and PCR resulted unspecific or negative on different occasions during the course of the disease. A confirmation of the diagnosis by complement-fixation antibody test was possible only after recovery from the disease. In Q fever with atypical clinical and serological presentation the screening of blood cells for inclusion bodies and liver or bone marrow tissue for granulomas may be important for establishing the diagnosis.
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität Düsseldorf.
authors.forename: A
authors.initials: A
authors.lastname: Erhardt
authors.forename: H
authors.initials: H
authors.lastname: Jablonowski
authors.forename: M
authors.initials: M
authors.lastname: Eick-Kerssenbrock
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.forename: D
authors.initials: D
authors.lastname: Reinecke
authors.forename: D
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000818:Animals; D001853:Bone Marrow / Q000473:pathology; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000473:pathology; D003168:Complement Fixation Tests; D003937:Diagnosis, Differential; D006098:Granulocytes / Q000473:pathology; D006099:Granuloma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011778:Q Fever / Q000175:diagnosis* / Q000473:pathology / Q000635:transmission; D012756:Sheep / Q000382:microbiology*; D015047:Zoonoses