A 71-year-old man presented to the emergency department with 3 weeks of fever, asthenia and night sweats. The initial laboratory results showed mild anaemia, thrombocytopenia and elevated C-reactive protein, with normal liver enzymes. The remaining initial study was unremarkable. Due to haematologic abnormalities, a bone marrow biopsy was performed, revealing multiple ring epithelioid granulomas, consisting of a central lipid vacuole surrounded by epithelioid cells and some neutrophils. These findings, although not pathognomonic, favoured the diagnosis of Q fever with isolated bone marrow involvement. The diagnosis was later confirmed by seroconversion and exclusion of other causes for this histopathologic finding. The patient was treated with doxycycline for fourteen days with a good response and no evidence of the disease after six months.
Aguiar et al. (Tue,) studied this question.