Presenter Status
Fellow
Abstract Type
Case report
Primary Mentor
Jacqueline Walker, MD MHPE
Start Date
14-5-2025 11:30 AM
End Date
14-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Q fever is a bacterial infection caused by Coxiella burnetii. Q fever commonly presents with flu-like symptoms (fever, chills, fatigue, myalgias) in patients about 2-3 weeks after exposure to farm animals. Less commonly, Q fever can cause severe illness such as myocarditis, pericarditis, or meningitis. We present a rare case of a pediatric patient with pericardial and pleural effusions secondary to Q fever.
Case presentation: History of present illness: The patient is a 9-year-old female who presented as a referral from an outside hospital due to chest pain, shortness of breath, and 2 weeks of fever. The patient started complaining of mild chest pain a month prior to presentation. She presented to her primary care provider and was placed on a course of antibiotics, however continued to have daily fevers and worsening chest pain. She was referred to an outside hospital emergency department where a CT scan demonstrated a large pericardial effusion (Image 1), and bilateral pleural effusions. The patient was referred for admission. Clinical course: The patient was initially admitted to the general pediatrics floor. An echocardiogram was obtained which was significant for a moderate pericardial effusion with intermittent right atrial collapse. Initial laboratory values are summarized in Table 1. A pericardiocentesis was performed, and a right chest tube was placed, both yielding serosanguineous fluid that was sent for further testing. The care team’s broad differential included infectious and inflammatory causes of polyserositis. Infectious disease and rheumatology were both consulted. The patient had multiple infectious exposures given that she lived on a farm that raised sheep and chickens, drank well water, and often played in the woods. Laboratory workup was broad and included Brucella, Coxiella, Tularemia, Mycoplasma and tuberculosis testing. Due to concern for potential Brucellosis, the patient was initiated on doxycycline. The patient remained stable following placement of pericardial drain and right chest tube. The patient’s pericardial drain and chest tubes were removed once no longer draining. The patient’s blood culture and aerobic cultures from pericardial and pleural fluid remained negative. Treatment: The patient received a 14-day course of oral doxycycline to cover for Coxiella and Brucella. Outcome/Follow-up: After discharge, the patient’s IgG phase II testing for Coxiella returned positive, indicating an acute Q fever infection. At outpatient follow up with Infectious Disease, the patient was doing well, was afebrile, and had normalization of inflammatory markers.
Discussion: Coxiella burnetti is present in the birth products of farm animals, including sheep, goats, and other livestock. Our patient had exposure to birthing sheep, likely putting her at risk for infection. Q fever infections are often self-limited, and children usually experience a milder illness course than adults. Our patient presented with severe complications that have rarely been reported in children. While Q fever can cause atypical pneumonia, it much more rarely presents with pleural effusions. Even rarer are cardiac complications in children. In the few case series describing pericardial effusions secondary to Q fever, only one patient was a child.
Q Fever Pericardial and Pleural Effusions in a Pediatric Patient
Background: Q fever is a bacterial infection caused by Coxiella burnetii. Q fever commonly presents with flu-like symptoms (fever, chills, fatigue, myalgias) in patients about 2-3 weeks after exposure to farm animals. Less commonly, Q fever can cause severe illness such as myocarditis, pericarditis, or meningitis. We present a rare case of a pediatric patient with pericardial and pleural effusions secondary to Q fever.
Case presentation: History of present illness: The patient is a 9-year-old female who presented as a referral from an outside hospital due to chest pain, shortness of breath, and 2 weeks of fever. The patient started complaining of mild chest pain a month prior to presentation. She presented to her primary care provider and was placed on a course of antibiotics, however continued to have daily fevers and worsening chest pain. She was referred to an outside hospital emergency department where a CT scan demonstrated a large pericardial effusion (Image 1), and bilateral pleural effusions. The patient was referred for admission. Clinical course: The patient was initially admitted to the general pediatrics floor. An echocardiogram was obtained which was significant for a moderate pericardial effusion with intermittent right atrial collapse. Initial laboratory values are summarized in Table 1. A pericardiocentesis was performed, and a right chest tube was placed, both yielding serosanguineous fluid that was sent for further testing. The care team’s broad differential included infectious and inflammatory causes of polyserositis. Infectious disease and rheumatology were both consulted. The patient had multiple infectious exposures given that she lived on a farm that raised sheep and chickens, drank well water, and often played in the woods. Laboratory workup was broad and included Brucella, Coxiella, Tularemia, Mycoplasma and tuberculosis testing. Due to concern for potential Brucellosis, the patient was initiated on doxycycline. The patient remained stable following placement of pericardial drain and right chest tube. The patient’s pericardial drain and chest tubes were removed once no longer draining. The patient’s blood culture and aerobic cultures from pericardial and pleural fluid remained negative. Treatment: The patient received a 14-day course of oral doxycycline to cover for Coxiella and Brucella. Outcome/Follow-up: After discharge, the patient’s IgG phase II testing for Coxiella returned positive, indicating an acute Q fever infection. At outpatient follow up with Infectious Disease, the patient was doing well, was afebrile, and had normalization of inflammatory markers.
Discussion: Coxiella burnetti is present in the birth products of farm animals, including sheep, goats, and other livestock. Our patient had exposure to birthing sheep, likely putting her at risk for infection. Q fever infections are often self-limited, and children usually experience a milder illness course than adults. Our patient presented with severe complications that have rarely been reported in children. While Q fever can cause atypical pneumonia, it much more rarely presents with pleural effusions. Even rarer are cardiac complications in children. In the few case series describing pericardial effusions secondary to Q fever, only one patient was a child.
