title: Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient.
abstract: Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be C. burnetii by PCR (polymerase chain reaction) sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.
authors.affiliation: Department of Infectious Diseases, Cleveland Clinic, OH, United States.
authors.forename: Shailee Y
authors.initials: SY
authors.lastname: Shah
authors.affiliation: Department of Infectious Diseases, Cleveland Clinic, OH, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kovacs
authors.affiliation: Department of Pathology, Cleveland Clinic, OH, United States.
authors.forename: Carmela D
authors.initials: CD
authors.lastname: Tan
authors.affiliation: Department of Cardiovascular Surgery, Cleveland Clinic, OH, United States.
authors.forename: Gosta
authors.initials: G
authors.lastname: Pettersson
authors.affiliation: Department of Infectious Diseases, Cleveland Clinic, OH, United States.
authors.forename: Nabin K
authors.initials: NK
authors.lastname: Shrestha
authors.affiliation: Department of Infectious Diseases, Western Michigan University, Kalamazoo, MI, United States.
authors.forename: Larry
authors.initials: L
authors.lastname: Lutwick
authors.affiliation: Department of Infectious Diseases, Cleveland Clinic, OH, United States.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
keywords: Coxiella burnetii endocarditis; Endocarditis and Etanercept; Q fever endocarditis; Unpasteurized milk infection