Case Presentation: A 33-year-old male with sporadic alcohol use presented with acute epigastric pain. Acute pancreatitis was diagnosed based on abdominal pain, elevated lipase, and imaging findings of pancreatic inflammation. Initial management included intravenous fluids and pain control. During his hospitalization, he developed acute transaminitis. An abdominal ultrasound revealed cholelithiasis without biliary or pancreatic duct obstruction, and a magnetic resonance cholangiopancreatography was unrevealing. He disclosed chronic fatigue and weight loss, as well as being a migrant worker from Central America who had traveled across the United States working in agriculture, most recently as a dairy farmer. A review of prior imaging identified small hepatic cysts. Given his systemic symptoms and exposure risk, Infectious Disease was consulted. Testing confirmed a Coxiella burnetii infection, the causative agent of Q fever. The patient was discharged on doxycycline and hydroxychloroquine. At follow-up, he reported improvement in symptoms and weight gain, but was later lost to care.
Discussion: Coxiella burnetii, also known as “Q fever”, is a zoonotic infection transmitted via contact with infected animals or contaminated products. Its clinical presentation varies widely, and symptoms are often non-specific including fever, fatigue, and weight loss. Acute pancreatitis is exceedingly uncommon, with few cases documented. When a patient presents with acute pancreatitis, it is reasonable to consider common risk factors such as alcohol use or cholelithiasis as the etiology. However, we considered alcohol as the etiology of our patient’s pancreatitis despite his report of limited use. It was not until we obtained a more thorough history revealing occupational exposure to livestock and chronic symptoms that led to the diagnosis of Q fever. This case highlights the importance of a comprehensive history in atypical presentations of common conditions like pancreatitis. While leukocytosis and transaminitis were attributed to pancreatic inflammation, they could have served as early indicators of infection. Discovering systemic symptoms and risk factors earlier could have expedited diagnosis and treatment. The mechanism linking Q fever to acute pancreatitis remains unclear but may involve direct pancreatic infection or immune-mediated injury. This rare manifestation highlights the need to consider zoonotic infections in patients with unusual clinical features, particularly those in high-risk occupations.
Conclusions: Though rare, infectious causes of pancreatitis, such as Q fever, should be considered in patients with atypical features or risk factors for zoonotic diseases. A detailed history, including occupational and travel exposures, is essential for timely diagnosis. This case underscores the importance of avoiding diagnostic anchoring and maintaining a broad differential to improve outcomes in uncommon clinical scenarios.
