Q fever Mitral Valve Endocarditis: A Disease Difficult to Diagnose and Treat

Q fever is a rare systemic infection caused by CoxiellaBurnetii.The presentation with Q fever endocarditis is insidious, with negative blood cultures, and often it is not obvious in diagnostic imaging studies until hemodynamic changes or valve destruction is reached. We report a case of Q fever endocarditis involving native mitral valve on top of rheumatic heart disease and severe mitral stenosis in 45 years old male admitted to the hospital with fever and left lower lobe pneumonia with pleural effusion. Was investigated for pulmonary Tuberculosis, which was negative. Echocardiography showed severe mitral valve stenosis with mass attached to the mitral valve leaflet. Blood cultures were negative. Serology for CoxiellaBurnetii was positive. Challenges in the diagnosis, surgical treatment and different aspects of this rare case are described.