title: Q fever endocarditis masquerading as Mixed cryoglobulinemia type II. A case report and review of the literature.
abstract: BACKGROUND
  The clinical manifestations of Q fever endocarditis are protean in nature. Mixed cryoglobulinemia type II is rarely a facet of the presenting clinical manifestations of Q fever endocarditis.
  
  
  METHODS
  We report a case of a 65-year-old pensioner with such an association and review the literature. As transesophageal echocardiograms are usually normal and blood cultures are usually negative in Q fever endocarditis, many of the manifestations (fever, rash, glomerulonephritis/evidence of renal disease, low serum C4 complement component, presence of mixed type II cryoglobulin, constitutional symptoms as arthralgias and fatigue) can be attributed to Mixed cryoglobulinemia type II per se. The use of Classic Duke Endocarditis Service criteria does not always suffice for the diagnosis of Q fever.
  
  
  CONCLUSIONS
  The application of the modified criteria proposed by Fournier et al for the improvement of the diagnosis of Q fever endocarditis will help to reach the diagnosis earlier and thus reduce the high mortality of the disease. We would like to stress the importance of ruling out the diagnosis of Q fever endocarditis in cases of mixed type II cryoglobulinemia.
authors.affiliation: Second Academic Department of Internal Medicine, University of Athens, Hippokration General Hospital, Athens, Greece. petrosr@otenet.gr
authors.forename: Petros I
authors.initials: PI
authors.lastname: Rafailidis
authors.forename: Spiros P
authors.initials: SP
authors.lastname: Dourakis
authors.forename: Christos A
authors.initials: CA
authors.lastname: Fourlas
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003449:Cryoglobulinemia / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D011778:Q Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents