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.

CASE PRESENTATION:

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: Emmanouil Angelakis, Simon-Djamel Thiberville, Matthieu Million, Didier Raoult
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 10 Issue 1 Pg. 139 (May 31 2016) ISSN: 1752-1947 [Electronic] England
• PMID: 27246557 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Infective Agents
• Hydroxychloroquine
• Doxycycline

Topics

• Aged
• Anti-Infective Agents (therapeutic use)
• Arthritis, Infectious (diagnostic imaging, drug therapy)
• Coxiella burnetii
• Doxycycline (therapeutic use)
• Humans
• Hydroxychloroquine (therapeutic use)
• Magnetic Resonance Imaging
• Male
• Osteomyelitis (diagnostic imaging, drug therapy)
• Positron Emission Tomography Computed Tomography
• Q Fever (diagnostic imaging, drug therapy)
• Sternoclavicular Joint (diagnostic imaging)