Q Fever Masquerading as Legionnaires Disease in an Endovascular Stent Infection

Abstract Background Legionellosis in the setting of preexisting endovascular prosthetic graft may represent a Coxiella burnetii infection as antibody cross-reactivity exists. Methods We present a 63-year-old man status-post endovascular aneurysm repair (EVAR) with a history of ankylosing spondylitis, chronic obstructive pulmonary disease asthma, coronary artery disease with myocardial infarction, hypertension, and hyperlipidemia who presented with clinical symptoms of legionellosis. This was confirmed with a positive urine antigen test. Results He completed a 21-day course of azithromycin for Legionella . His leukocytosis and liver function tests normalized, but he had continued lethargy and a persistently elevated erythrocyte sedimentation rate and C-reactive protein. Imaging showed a radiographically infected EVAR graft (placed 10 months prior). The EVAR was explanted and the operating room cultures grew C. burnetii . Prolonged hydroxychloroquine and doxycycline therapy were required for vascular manifestations of Coxiella as azithromycin provides inappropriate coverage. Conclusions Persistent constitutional symptoms in the setting of an EVAR require expanded investigation, especially in the setting of legionellosis.