{"id":13501,"date":"2022-05-25T18:32:06","date_gmt":"2022-05-25T22:32:06","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/im-residency\/?page_id=13501"},"modified":"2022-05-26T10:35:35","modified_gmt":"2022-05-26T14:35:35","slug":"research-week-2022-emily-mann-md","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/im-residency\/research-week-2022-emily-mann-md\/","title":{"rendered":"Research Week 2022 – Emily Mann, MD"},"content":{"rendered":"

\"\"<\/p>\n

Culture Negative Endocarditis and Recurrent Fevers<\/p>\n

Emily Mann<\/p>\n

Learning Objectives<\/strong><\/p>\n

    \n
  1. Recognize a common Q fever endocarditis presentation<\/li>\n
  2. Define persistent focal Q fever<\/li>\n
  3. Understanding the importance of lymphadenopathy in the setting of Q fever<\/li>\n<\/ol>\n

    A 40 year old male with a past medical history of rheumatic heart disease presented to<\/p>\n

    his primary care doctor for two years of worsening, intermittent fevers.<\/p>\n

    The patient had lived all over the world, including various parts of Africa and Europe. He<\/p>\n

    took no medications and used no illicit drugs. He worked in construction and lived in the<\/p>\n

    suburbs of Massachusetts with his family. He had no pets. His only exposure to<\/p>\n

    livestock was about three years prior to presentation at a fair.<\/p>\n

    Over the course of his evaluation for fevers, he began to have dyspnea on exertion and<\/p>\n

    orthopnea, so he underwent transthoracic echocardiogram. The echocardiogram<\/p>\n

    revealed a bicuspid aortic valve with a large mobile density and severe aortic<\/p>\n

    insufficiency, so he was admitted to the hospital for further work up.<\/p>\n

    Blood cultures were drawn prior to initiation of antibiotics and were negative. Labs were<\/p>\n

    significant for a normal white blood count and differential, mild anemia, normal platelets,<\/p>\n

    mildly elevated liver function tests, elevated inflammatory markers and an elevated<\/p>\n

    protein gap. MRI revealed massive splenomegaly and intra-abdominal<\/p>\n

    lymphadenopathy. Physical exam was significant only for a loud diastolic murmur over<\/p>\n

    the right upper sternal border and splenomegaly. Concern was primarily for subacute,<\/p>\n

    bacterial endocarditis, though the differential included malignancy and rheumatologic<\/p>\n

    disorders.<\/p>\n

    Repeat blood cultures throughout the admission were negative, but empiric antibiotics<\/p>\n

    were started. Lactate dehydrogenase was within normal limits. Peripheral flow<\/p>\n

    cytometry was normal. Serum protein electrophoresis and immunofixation suggested<\/p>\n

    only generalized inflammation. Seven days following admission, his Q fever antibody<\/p>\n

    IGG and IGM returned positive and he was started on a prolonged course of<\/p>\n

    hydroxychloroquine and doxycycline with improvement of his fevers. He eventually<\/p>\n

    underwent aortic valve replacement and, following his 12 month antibiotic course, his<\/p>\n

    splenomegaly and lymphadenopathy resolved.<\/p>\n

    Despite this patient\u2019s chronic fevers and endocarditis being classic features of persistent<\/p>\n

    focal Q fever, it was not highest on the differential. The clinical presentation of Q fever<\/p>\n

    varies significantly and this case demonstrates the importance of keeping Q fever on<\/p>\n

    the differential even when acute exposure is not obvious.<\/p>\n

    References<\/strong><\/p>\n

      \n
    1. Melenotte C, Protopopescu C, Million M, et al. Clinical Features and Complications of<\/li>\n<\/ol>\n

      Coxiella burnetii Infections From the French National Reference Center for Q Fever.<\/p>\n

      JAMA Netw Open. 2018;1(4):e181580. doi:10.1001\/jamanetworkopen.2018.1580<\/p>\n

        \n
      1. Angelakis, E., & Raoult, D. (2010). Q fever. Veterinary Microbiology, 140(3-4),<\/li>\n<\/ol>\n

        297\u2013309. https:\/\/doi.org\/10.1016\/j.vetmic.2009.07.016<\/p>\n

          \n
        1. Elzein, F. E., Alsherbeeni, N., Alnajashi, K., Alsufyani, E., Akhtar, M. Y., Albalawi, R.,<\/li>\n<\/ol>\n

          Albarrag, A. M., Kaabia, N., Mehdi, S., Alzahrani, A., & Raoult, D. (2019). Ten-year<\/p>\n

          experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia.<\/p>\n

          International Journal of Infectious Diseases, 88, 21\u201326.<\/p>\n

          https:\/\/doi.org\/10.1016\/j.ijid.2019.07.035<\/p>\n

            \n
          1. Mark R. Armstrong, Kate L. McCarthy & Robert L. Horvath (2018) A contemporary<\/li>\n<\/ol>\n

            16-year review of Coxiella burnetii <\/em>infective endocarditis in a tertiary cardiac center in<\/p>\n

            Queensland, Australia, Infectious Diseases, 50:7, 531-538, DOI:<\/p>\n

            10.1080\/23744235.2018.1445279<\/p>\n","protected":false},"excerpt":{"rendered":"

            Culture Negative Endocarditis and Recurrent Fevers Emily Mann Learning Objectives Recognize a common Q fever endocarditis presentation Define persistent focal Q fever Understanding the importance of lymphadenopathy in the setting of Q fever A 40 year old male with a past medical history of rheumatic heart disease presented to his primary care doctor for two […]<\/p>\n","protected":false},"author":18326,"featured_media":0,"parent":0,"menu_order":26,"comment_status":"open","ping_status":"closed","template":"page-templates\/no-sidebars.php","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/pages\/13501"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/users\/18326"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/comments?post=13501"}],"version-history":[{"count":1,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/pages\/13501\/revisions"}],"predecessor-version":[{"id":13507,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/pages\/13501\/revisions\/13507"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/media?parent=13501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}