Biopsy-confirmed acute Q fever hepatitis complicating severe alcohol-associated hepatitis: a diagnostic and management challenge.

Authors

Ali Galalah Mostafa Ismail, Dilini Gunawardena, Justin Chin

Published in

BMJ case reports. Volume 19. Issue 8. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

We describe the case of a woman in her 40s with heavy alcohol use who presented with jaundice, persistent fever and severe liver dysfunction initially managed as alcohol-associated hepatitis. Despite broad-spectrum antibiotics and negative septic screening, she remained febrile. Further investigation, prompted by rural livestock exposure and recent family exposure to Q fever, revealed acute Coxiella burnetii infection, supported by phase II-predominant Q fever serology, including phase II IgG IFA titre 1:2048, and positive serum/blood PCR. Liver biopsy demonstrated moderate-to-severe alcohol-associated steatohepatitis with numerous fibrin-ring granulomas, confirming dual pathology. Fever resolved after doxycycline was commenced; however, severe hepatic dysfunction persisted. Prednisolone was initiated after doxycycline had started, fever had resolved and no uncontrolled bacterial focus was identified, resulting in marked biochemical improvement and a Lille score of 0.054. This case highlights the challenge of distinguishing infection from sterile inflammation in alcohol-associated hepatitis and emphasises the importance of considering atypical zoonotic infection before immunosuppressive therapy.

PMID:
42601077
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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