title: Sternoclavicular joint infection caused by Coxiella burnetii: a case report.
abstract: BACKGROUND
  Few cases of Q fever osteoarticular infection have been reported, with chronic osteomyelitis as the most common manifestation of Q fever osteoarticular infection. Here we present the case of a sternoclavicular joint infection caused by Coxiella burnetii and localized by positron emission tomography scanning.
  
  
  METHODS
  A 67-year-old French man from south France was hospitalized for fever and confusion. An examination revealed subclavicular and axillary lymph node enlargement. Computed tomography scanning and transesophageal echocardiogram were normal, and magnetic resonance imaging scanning did not reveal signs of infection. An immunofluorescence assay of an acute serum sample was positive for C. burnetii and he was treated with 200 mg doxycycline for 21 days. An immunofluorescence assay of convalescent serum sampled after 2 months revealed very high C. burnetii antibody titers. To localize the site of the infection, we performed positron emission tomography scanning, which revealed intense fluorodeoxyglucose uptake in his right sternoclavicular joint; treatment with 200 mg oral doxycycline daily and 200 mg oral hydroxychloroquine three times daily for 18 months was initiated.
  
  
  CONCLUSIONS
  Q fever articular infections may be undiagnosed, and we strongly urge the use of positron emission tomography scanning in patients with high C. burnetii antibody titers to localize the site of C. burnetii infection.
authors.affiliation: URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France. e.angelakis@hotmail.com.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Angelakis
authors.affiliation: UMR190, Aix-Marseille Université / IRD / EHESP French School of Public Health, Marseille, France.|Hospital Louis Raffalli, Medicine D Unit, Infectious Disease and Internal Medicine, Manosque, France.
authors.forename: Simon-Djamel
authors.initials: SD
authors.lastname: Thiberville
authors.affiliation: URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Million
authors.affiliation: URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016997:Coxiella burnetii; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000072078:Positron Emission Tomography Computed Tomography; D011778:Q Fever / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging*
chemical_list: D000890:Anti-Infective Agents; D006886:Hydroxychloroquine; D004318:Doxycycline
keywords: Case report; Coxiella burnetii; Osteoarticular infection; Q fever; Sternoclavicular joint infection