Computed tomography scanning and transesophageal echocardiogram were normal, and magnetic resonance imaging scanning did not uncover signs of infection. the use of positron emission tomography scanning in patients with high antibody titers to localize the site of contamination. . Infective endocarditis is the most frequent Q fever chronic contamination, followed by vascular, osteoarticular, hepatitis and pulmonary contamination . To date, few cases of Q fever osteoarticular contamination have been reported in the literature; they include osteomyelitis, spondylodiscitis and two cases of tenosynovitis [2, 3]. In fact, only seven (2 %) osteoarticular infections were PSI-352938 detected in a large serologic study which included more than 1300 cases of Q fever that extended over 14 years , and 11 (0.7 %) cases in a recent 7-year study which included more than 1400 cases . Osteomyelitis is the most common manifestation of Q fever osteoarticular contamination, followed by vertebral spondylodiscitis and paravertebral abscess [1, 2]. has also been implicated in a prosthetic joint contamination , while two cases of tenosynovitis have been reported . Q fever osteoarticular contamination can easily go undiagnosed because of the long development of articular involvement, which is usually accompanied by a low level of laboratory and inflammatory indicators . However, in recent years, positron emission tomography (PET) scanning has been successfully utilized for the identification of infectious foci in infections [1, 7], and the use of PET scanning was recently proposed as a complementary tool for patients with high antibody titers in order to localize the site of contamination [1, 8]. Here we PSI-352938 present a case of a sternoclavicular joint contamination caused by by quantitative polymerase chain reaction Mouse monoclonal to ZBTB16 (qPCR) for the Is usually1111 and the Is usually30A spacers . A localized contamination was suspected; lymph node biopsies were performed that were unfavorable for by molecular assays. For each sample, we verified the quality of DNA handling and extraction of samples by qPCR for any housekeeping gene encoding beta-actin . The PSI-352938 lymph node biopsies were also unfavorable for by immunohistochemical PSI-352938 analysis using a monoclonal antibody against with an immunoperoxidase kit . Moreover, the lymph nodes were also tested by fluorescent hybridization (FISH) , which was also negative. To localize the site of the contamination we performed PET scanning, which revealed intense fluorodeoxyglucose uptake in his right sternoclavicular joint (Fig.?1). A diagnosis of sternoclavicular joint contamination by was made, and treatment with 200 mg oral doxycycline daily and 200 mg oral hydroxychloroquine three times daily for 18 months was launched. After 6 months follow-up, the outcome was favorable, with a four-fold decrease in the phase I and phase II IFA titers for IgG. Open in a separate windows Fig. 1 18F-fluorodeoxyglucose positron emission tomography computed tomography in a patient with sternoclavicular joint contamination. The high fluorodeoxyglucose uptake (vascular infections , in the bone marrow , in the liver , and recently two cases of arthritis and subacromial bursitis caused by were also localized . In this case we suspected a localized contamination because of the very high IFA titers and IgG-aCL levels . In fact, prolonged localized infections have been associated with increased levels of IgG and IgA antibodies . However, echocardiography did not reveal indicators of endocarditis and lymph nodes were unfavorable for As Q fever articular infections PSI-352938 present a long development of articular involvement, accompanied by a low level of inflammatory indicators, and can very easily remain undiagnosed , the PET scanner was a valuable tool for the identification and the localization of the infectious foci of in the sternoclavicular joint. Although we did not test the sternoclavicular joint to confirm the diagnosis, a localized contamination with is associated with high antibody titers against . For our patient the only fluorodeoxyglucose uptake was in the right sternoclavicular joint indicating that this was the site of fixation. Epidemiological patterns of Q fever osteoarticular infections may consist of sporadic cases that are hard.