Wiener klinische Wochenschrift · 2026
Q fever meningoencephalitis with neurological relapse and atypical cerebrospinal fluid findings : A case report and minireview of the literature.
СтатьяНазвание и аннотация: Перевод в очереди
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Saletinger Rajko, Grasselli Kmet Nina, Jereb Matjaž, Avšič Županc Tatjana
Аннотация
BACKGROUND: Neurological involvement in Q fever is rare, often presenting with non-specific symptoms and posing significant diagnostic challenges. We report a case of Q fever meningoencephalitis characterized by a relapse of neurological symptoms and atypical cerebrospinal fluid findings. In addition, we conducted a review of published English language cases of acute Q fever with neurological manifestations reported over the past 35 years.
CASE PRESENTATION: A 49-year-old previously healthy woman presented with acute aphasia and somnolence. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with elevated protein. Brain imaging was unremarkable, while the electroencephalogram demonstrated bilateral frontotemporal slowing. After initial improvement, she experienced a relapse with transient aphasia, confusion and fever. A repeat lumbar puncture revealed neutrophilic pleocytosis with elevated protein. Extensive investigations excluded viral, bacterial, autoimmune and neoplastic etiologies. Serology identified infection with Coxiella burnetii. She was treated with doxycycline for 14 days and made a complete recovery.
CONCLUSION: This case highlights the diagnostic complexity of Q fever meningoencephalitis, presenting with a relapse of neurological symptoms and unusual cerebrospinal fluid findings. These features may reflect infection-related inflammation, although postinfectious vasculitis or seizure-related phenomena cannot be excluded. The case underscores the importance of considering Q fever in atypical or fluctuating meningoencephalitis, even in regions with low incidence, and illustrates the diagnostic value of serology. We also provide a review of previously reported neurological manifestations of acute Q fever to provide broader clinical context. While the overall clinical and serological findings strongly support Q fever-associated central nervous system involvement, some degree of diagnostic uncertainty remains given the multifactorial mechanisms that may contribute to neurological manifestations.
CASE PRESENTATION: A 49-year-old previously healthy woman presented with acute aphasia and somnolence. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with elevated protein. Brain imaging was unremarkable, while the electroencephalogram demonstrated bilateral frontotemporal slowing. After initial improvement, she experienced a relapse with transient aphasia, confusion and fever. A repeat lumbar puncture revealed neutrophilic pleocytosis with elevated protein. Extensive investigations excluded viral, bacterial, autoimmune and neoplastic etiologies. Serology identified infection with Coxiella burnetii. She was treated with doxycycline for 14 days and made a complete recovery.
CONCLUSION: This case highlights the diagnostic complexity of Q fever meningoencephalitis, presenting with a relapse of neurological symptoms and unusual cerebrospinal fluid findings. These features may reflect infection-related inflammation, although postinfectious vasculitis or seizure-related phenomena cannot be excluded. The case underscores the importance of considering Q fever in atypical or fluctuating meningoencephalitis, even in regions with low incidence, and illustrates the diagnostic value of serology. We also provide a review of previously reported neurological manifestations of acute Q fever to provide broader clinical context. While the overall clinical and serological findings strongly support Q fever-associated central nervous system involvement, some degree of diagnostic uncertainty remains given the multifactorial mechanisms that may contribute to neurological manifestations.