Heart transplantation for end-stage heart failure combined with Q fever isolated to the heart: a case report

Marcel van 't Veer, Luuk Otterspoor, Marieke de Regt, Kathinka Peels, Jola Evens, Aryan Vink, Nicolaas de Jonge

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Abstract

Background : Active infection is generally considered a contraindication for heart transplantation. The rare combination of a patient with an active Coxiella burnetii infection and a congenital corrected transposition of the great arteries requiring heart transplantation impose challenging treatment decisions. We would like to demonstrate that if Q fever is restricted to the heart only, heart transplantation is also beneficial from an infectious point of view, therefore treating two severe conditions simultaneously.

Case summary : A patient with end-stage heart failure due to congenital corrected transposition of the great arteries and requiring heart transplantation developed chronic Q fever and endocarditis. Different antibiotic regimes were tried due to severe adverse reactions. Antibiotic treatment was precisely monitored by measuring Q fever polymerase chain reaction (PCRs) and phase I IgG antibody titres. A positron emission tomography scan revealed that Q fever was confined to the heart only after which it was decided to perform heart transplantation. Based on the results of PCR and antibody testing, antibiotic treatment was stopped after 1 year. After 5 years of follow-up, patient is still in an optimal condition.

Discussion : In case of a patient with end-stage heart failure and chronic Q fever, a combined treatment with PCR-/antibody monitored antibiotics and heart transplantation can cure both conditions.

Original languageEnglish
Article numberytaa435
Pages (from-to)1-4
Number of pages4
JournalEuropean Heart Journal - Case Reports
Volume4
Issue number6
DOIs
Publication statusPublished - 5 Dec 2020

Keywords

  • Case report
  • Coxiella burnetii
  • Endocarditis
  • Heart failure
  • Heart transplantation
  • Q fever

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