title: Clinicopathologic features of q Fever patients with acute hepatitis.
abstract: BACKGROUND
  Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described.
  
  
  METHODS
  Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests.
  
  
  RESULTS
  All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure.
  
  
  CONCLUSIONS
  C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Miji
authors.initials: M
authors.lastname: Lee
authors.forename: Jae Jeong
authors.initials: JJ
authors.lastname: Jang
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Eunsil
authors.initials: E
authors.lastname: Yu
keywords: Coxiella burnetii; Granuloma; Hepatitis; Liver biopsy; Q fever