Chronic Q fever, caused by Coxiella burnetii, can mimic sarcoidosis and cause diagnostic delays. We report a 45-year-old Iranian man with hypertrophic obstructive cardiomyopathy with implantable cardioverter defibrillator placement, found to have splenomegaly and thrombocytopenia, later developing fatigue, night sweats, weight loss, polyarthralgia, and persistent cytopenia. Lymphoma was initially suspected, but biopsies showed rare noncaseating granulomas. Sarcoidosis was considered. However, symptoms persisted despite corticosteroids. An infectious disease work-up confirmed chronic Q fever. This case underscores the need to include Q fever in the differential of unexplained granulomatous disease, particularly when atypical for sarcoidosis or refractory to immunosuppression.
Lin et al. (Thu,) studied this question.