title: Coxiella burnetii as a possible cause of autoimmune liver disease: a case report.
abstract: BACKGROUND
  Q fever is a zoonotic infection that may cause severe hepatitis. Q-fever hepatitis has not yet been associated with autoimmune hepatitis and/or primary biliary cirrhosis.
  
  
  METHODS
  We describe a 39-year-old man of Sri Lankan origin with chronic Q-fever hepatitis who developed autoantibodies compatible with autoimmune hepatitis/primary biliary cirrhosis overlap syndrome. Ursodeoxycholic acid in addition to antibiotic therapy markedly improved hepatic enzyme levels suggesting that autoimmunity, potentially triggered by the underlying infection, was involved in the pathogenesis of liver damage.
  
  
  CONCLUSIONS
  We suggest that Coxiella burnetii might trigger autoimmune liver disease. Patients with Q-fever hepatitis who respond poorly to antibiotics should be investigated for serological evidence of autoimmune hepatitis, primary biliary cirrhosis or overlap syndrome, as these patients could benefit from adjunctive therapy with ursodeoxycholic acid. Conversely, C. burnetii serology might be necessary in patients with autoimmune liver disease in order to exclude underlying Coxiella infection.
authors.forename: Chloe
authors.initials: C
authors.lastname: Kaech
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pache
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Gilbert
authors.initials: G
authors.lastname: Greub