A case of giant cell arteritis associated with culture-proven Coxiella burnetii aortitis. (April 2018) - de Worm, S.
Highlights: The patient presented culture-proven aortitis due to Coxiella burnetii infection. The patient also fulfilled the ACR criteria for giant cell arteritis (GCA). A pathophysiological link between the two diseases is likely. It should be avoided to retain a diagnosis of chronic Q fever on the sole basis of biological criteria without clinically evident infection. The case was managed in collaboration with experts of the French Reference Centre for Coxiella infections (Dr Million and Prof. Raoult). Abstract: A case of proven Coxiella burnetii aortitis, possibly associated with giant cell arteritis (GCA), is reported. A 72-year-old man, who is a hunter, presented with weight loss, fever, jaw claudication, and hardened temporal arteries associated with a persistent inflammatory syndrome and arteritis of the whole aorta, including the brachiocephalic arteries, as seen on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. The diagnosis of GCA was retained, and treatment with prednisolone was started. Given the aneurysm of the abdominal aorta, the patient underwent replacement of the abdominal aorta with an allograft. Histology showed intense chronic arteritis attributed to atherosclerosis with dissection. However, Coxiella burnetii infection was confirmed by serology and then by culture and molecular biology on the surgical specimen. A combination of hydroxychloroquine and doxycycline was added to tapered prednisolone and the outcome was favourable.