Q fever presenting as miliary pneumonia: Case imagery and differential diagnosis

Abstract

CASE/IMAGERY DESCRIPTION: A 56-year-old immunocompetent male consulted for one month of relapsing fever, moderate dyspnea, nonproductive cough, headaches, and myalgias. Past medical history was unremarkable except for exposure to a variety of livestock carcasses. A computed tomographic scan revealed innumerable randomly distributed 1–3 mm micronodules. Initial diagnostic workup including bronchoalveolar lavage (BAL) was inconclusive.

STUDY QUESTIONS: Is this miliary pneumonia? What diagnosis must initially be considered? In this specific case with negative BAL analysis/cultures, what would your differential diagnosis be? Is Q fever a possibility?

Keywords:

• Q fever
• Coxiella burnetti
• miliary pneumonia
• atypical pneumonia
• nonresolving pneumonia
• Computed Tomography (CT)
• occupational exposure