title: Central nervous system manifestations of Q fever responsive to steroids.
abstract: We report the clinical and radiological central nervous system manifestations of a 27-year-old man with Q fever who subsequently developed acute disseminated encephalomyelitis and showed a significant response to steroids. The patient presented with headache and fever and quickly progressed to develop acute respiratory failure and hepatitis. A prompt evaluation revealed positive serology for Q fever and doxycycline was initiated. Approximately 1 week into his illness he was noted to be profoundly weak. Neuroimaging with magnetic resonance imaging (MRI) revealed diffuse white matter T2/FLAIR hyperintensities, with evidence of restricted diffusion. He was given high-dose steroids for a presumed diagnosis of acute disseminated encephalomyelitis (ADEM) and within days he had both clinical and MRI improvement. In addition to well-described meningitis and encephalitis, Q fever may also be associated with diffuse CNS lesions that may be demyelinating inflammatory in pathophysiology, and therefore responsive to high-dose steroids.
authors.affiliation: Department of Neurology, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC 20307, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Skiba
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Barner
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000209:etiology*; D016997:Coxiella burnetii; D004318:Doxycycline / Q000627:therapeutic use; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy* / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007493:Iraq; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D011778:Q Fever / Q000150:complications / Q000188:drug therapy*; D011859:Radiography; D014481:United States; D015047:Zoonoses
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D004318:Doxycycline; D011241:Prednisone