Winter-Onset Acute Q fever Presenting as Atypical Pneumonia with Hepatitis in the Absence of Epidemiological Risk Factors: A Case Report

Q fever is a zoonotic disease that typically occurs in the spring and is commonly associated with animal exposure; however, atypical epidemiological and clinical presentations may lead to diagnostic challenges. In this report, a 34-year-old male patient without a history of animal contact presented in February with fever, cough, and dyspnea, and was diagnosed with community-acquired pneumonia. The lack of response to beta-lactam therapy and the subsequent development of asymptomatic transaminase elevation were notable findings. Serological testing revealed elevated Phase II IgG and IgM antibody titers against Coxiella burnetii, which, together with the compatible clinical presentation, supported the classification of the case as probable acute Q fever presenting with pneumonia and concomitant hepatitis. Clinical and biochemical improvement was achieved with levofloxacin therapy. This case highlights that Q fever may occur during the winter months and in the absence of identifiable epidemiological risk factors, and that the coexistence of pneumonia and hepatitis may provide important diagnostic clues. Q fever should be considered in the differential diagnosis of pneumonia cases unresponsive to empirical antibiotic therapy.