title: Fulminant hepatic failure and acute renal failure as manifestations of concurrent Q fever and cytomegalovirus infection: a case report.
abstract: BACKGROUND
  Coxiella burnetii is an obligate bacterial pathogen that causes Q fever. Cytomegalovirus (CMV) commonly exists as a latent infection in healthy people. Co-infection with both pathogens is rare.
  
  
  METHODS
  We report an immunocompetent 53-year-old male farmer who presented with fulminant hepatic failure and acute renal failure. Empiric antibiotic treatment with intravenous penicillin G and levofloxacin were given, but hepatic and renal functions continued to deteriorate. A subsequent test of serum immunoglobulin M was positive for CMV, and administration of gancyclovir led to gradual recovery. A diagnosis of acute Q fever was confirmed by indirect immunofluorescence assay (IFA) on paired serum samples to demonstrate a significant rise in antibody titers. Antibiotic treatment was adjusted accordingly.
  
  
  CONCLUSIONS
  CMV co-infection should be considered in patients with acute Q fever when they do not respond to standard antimicrobial agents.
authors.affiliation: School of Medicine, Tzuchi University, Hualien, Taiwan. Elliot771013@Hotmail.com.
authors.forename: Jin-Yi
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: School of Medicine, Tzuchi University, Hualien, Taiwan. antibody_1@msn.com.|Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No 2, Ming-Shen Road, Dalin Town, Chia-Yi County, 622, Taiwan. antibody_1@msn.com.
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: School of Medicine, Tzuchi University, Hualien, Taiwan. tsengkuochih@gmail.com.|Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No 2, Ming-Shen Road, Dalin Town, Chia-Yi County, 622, Taiwan. tsengkuochih@gmail.com.
authors.forename: Kuo-Chih
authors.initials: KC
authors.lastname: Tseng
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D060085:Coinfection / Q000150:complications / Q000175:diagnosis*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000150:complications / Q000175:diagnosis*