Acute Q fever in third trimester pregnancy.

A 29-year-old gravida 2 para 1 woman presented at 29 weeks gestation with fevers, back pain, thrombocytopenia and hepatitis. PCR testing of blood samples detected Coxiella burnetii and paired serology later confirmed the diagnosis of acute Q fever in pregnancy. The patient was treated empirically with oral clarithromycin and experienced a symptomatic and biochemical improvement. Therapy was changed to oral trimethoprim/sulphamethoxazole but was complicated by a delayed cutaneous reaction, prompting recommencement of clarithromycin. Therapy continued until delivery of a healthy girl at 39 weeks and 3 days. Q fever in pregnancy is likely under-reported and is associated with the development of chronic infection and obstetric complications. Treatment with clarithromycin is an alternative to trimethoprim/sulphamethoxazole in the setting of drug intolerance.