PATIENT HISTORY: A 33-year old Romanian chef presented with sudden onset of chest pain and chills as well as a significant elevation of myocardial markers and CRP.
EXAMS: Coronary angiography showed no signs of relevant atherosclerosis. A myocarditis was assumed and later diagnosed on cardiac MRI.
DIAGNOSTICS: Due to fevers up to 40 °C and occupational history, Q fever was assumed. Serologic findings confirmed the diagnosis.
THERAPY AND COURSE OF EVENTS: After the start of antibiotic treatment, temperatures remained normal and the patient could be discharged a few days later. Azithromycin was recommended for several weeks to prevent a chronic infection. At the check-up visit one month later the patient appeared to have no signs of chronic heart failure or persistent infection.
CONCLUSIONS: Myocarditis is a rare manifestation of Q fever, which should not be missed. The diagnostic evaluation with antibody titers is easy. The antibiotic therapy is well tolerated and is a causal treatment that helps to prevent long-term damage.
