Melissa Magrath M.D., Michelle Pearlman M.D., Lan Peng M.D., William Lee M.D.
A 41-year-old man presented with persistent fevers and elevated liver enzymes. Percutaneous liver biopsy revealed fibrin ring granulomas and serologic testing confirmed acute Q fever. Interestingly, his fevers did not resolve with doxycycline alone, and he only clinically improved after hydroxychloroquine was initiated. We discuss the differential diagnosis of fibrin- ring granulomas on liver biopsy as well as the clinical features and treatment of Q fever.View pdf