Acute Q Fever Presenting with Severe Cholestatic Jaundice and Acute Kidney Injury in the Absence of Classic Exposure: A Rare Case Report.

Abstract

Q fever, caused by Coxiella burnetii, is a zoonotic infection with highly variable clinical manifestations, often leading to diagnostic delays. Although typically associated with livestock exposure and presenting with nonspecific febrile illness or hepatitis, its clinical spectrum is broad. We report an unusual case of a 53-year-old previously healthy male who presented with high-grade fever, epigastric pain radiating to both upper quadrants, marked jaundice, severe acute kidney injury, and dark urine. Initial imaging revealed bilateral perinephric and periureteral stranding, gallbladder wall edema, and absence of biliary obstruction, raising concern for urinary and hepatobiliary pathology. Serologic testing for viral hepatitis and multiple bacterial pathogens was negative. Persistent cholestatic abnormalities and systemic symptoms prompted an expanded infectious workup, which revealed positive Coxiella burnetii IgG and IgM. Doxycycline therapy resulted in rapid clinical improvement and progressive normalization of renal and hepatic parameters, confirming acute Q fever based on compatible clinical presentation, positive serology, exclusion of alternative diagnoses, and response to doxycycline. This case is notable for the coexistence of cholestatic jaundice, severe renal dysfunction, and urinary symptoms without pulmonary or classical hepatitic features, illustrating a rare phenotype of acute Q fever. Additionally, the absence of identifiable exposure risks underscores ongoing under recognition of this infection outside traditional high-risk settings. The patient's favorable response to timely doxycycline treatment highlights the importance of considering Q fever in the differential diagnosis of febrile jaundice with multiorgan involvement. This report reinforces the value of broad infectious evaluation in atypical presentations and contributes to expanding clinical awareness of Q fever's diverse manifestations.