CTICasesAcute Q Fever Pneumonia
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Imaging findings
Initial chest radiograph showed hypoinflation. Subsequent radiographs revealed lower lobe consolidation and basal opacities, particularly after rapid progression to respiratory failure. CT imaging performed two weeks after presentation, despite motion artifact, suggested small nodules, dependent consolidation, ground glass opacities, and distinct subpleural lymphatic nodules, particularly along the fissures.
Key takeaways
This case illustrates acute Q fever (Coxiella burnetii pneumonia) in a dairy farm worker, characterized by acute respiratory failure, fever, and a notable bradycardia, which is a classic but often overlooked clinical sign. The imaging showed consolidating pneumonia and subtle lymphatic nodules. Q fever, a zoonosis transmitted by livestock, should be considered in the differential for severe community-acquired pneumonia unresponsive to standard antibiotics, especially in patients with relevant occupational exposures. It responds well to doxycycline.
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