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15 December 2020 : Case report  Kuwait

Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge

Mistake in diagnosis, Diagnostic / therapeutic accidents, Rare coexistence of disease or pathology

Ahmed Alqallaf1AB*, Abdulmohsen Alhashim2D, Mohammad Alajmi3BF, Ameerah Alsaqobi4E, Wasl Al-Adsani4EF

DOI: 10.12659/AJCR.926699

Am J Case Rep 2020; 21:e926699

Abstract

BACKGROUND: There is a close association between Q fever and autoimmune disease, with some case reports in the literature of Q fever presenting as systemic lupus erythematosus (SLE) and others documenting their coexistence. However, making the correct diagnosis remains challenging and Q fever often is overlooked. Therefore, it is essential to review such a rare presentation to help in accurate diagnosis in future cases. This report is of a case of endocarditis due to Coxiella burnetii in a patient with Q fever and a history of SLE.

CASE REPORT: We report the case of a 43-year-old man with a history of SLE and rheumatic heart disease, status post-valve replacement. The patient initially presented with an acute kidney injury in the setting of a history of full-house lupus membranous nephropathy, which was diagnosed on kidney biopsy. The patient had been on immunosuppressive therapy for 2 years. Shortly after he was admitted, echocardiography was ordered because the patient had progressive dyspnea, revealing infective endocarditis involving multiple valves. He underwent valve repair surgery and was placed on an extended course of antibiotic therapy. His symptoms gradually resolved, with normalization of his immunological markers. The patient’s immunosuppressive regimen was eventually discontinued. He remains on lifelong antibiotic suppression therapy.

CONCLUSIONS: This case highlights the importance of awareness of infectious causes of endocarditis in patients with underlying autoimmune diseases such as SLE. This rare case of C burnetii endocarditis may have been associated with underlying valvular SLE.

Keywords: Endocarditis, Lupus Erythematosus, Systemic, Q Fever

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923