Stheme de Jubécourt Aymery, Hocquart Marie, Picaud Olivier, Farvacque Georges, Edouard Sophie, Beaudoin Louis, Bitoun Romain, Lepidi Hubert, Fenollar Florence, Fournier Pierre-Edouard, Million Matthieu
Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 boulevard Jean Moulin, Marseille, 13005, France.
French Reference Center for Rickettsioses, Q Fever and Bartonelloses, Marseille, France.
Eur J Clin Microbiol Infect Dis. 2025 Jul 8. doi: 10.1007/s10096-025-05193-7.
Coxiella burnetii is an underestimated cause of acalculous cholecystitis. Large studies recently allowed to identify a dose-dependent association with IgG anticardiolipin. The management and long-term complications of Q fever-associated cholecystitis remain to be determined.
We describe a surgical case from Martigues, France, which is an endemic area and performed a systematic review of C. burnetii cholecystitis cases associated with Q Fever.
Twenty-seven patients were included, including 3 (11.1%) children. All cases were reported during acute Q fever, followed by recurrent pancreatitis and chronic cholecystitis in 1 (3.7%) case. Two (2/2, 100%) were proven by a positive PCR on gallbladder but immunohistochemistry was negative in all cases. Only 3 (11.1%) cases were calculous. Coxiella burnetii cholecystitis is atypic because it is acalculous, with a flu-like syndrome, lupus anticoagulant, anticardiolipin antibodies and thrombocytopaenia.
Serology and PCR from blood and gallbladder biopsies are key to the aetiological diagnosis of C. burnetii cholecystitis. Inflammatory and/or autoimmune mechanism is suspected. Doxycycline remains the first-line therapy. Future prospective studies should determine whether treatment with doxycycline and hydroxychloroquine can prevent the chronic evolution of the disease in patients who initially present with antiphospholipid antibodies.
伯氏考克斯体是无结石性胆囊炎一个未得到充分重视的病因。近期的大型研究发现其与IgG抗心磷脂抗体存在剂量依赖性关联。Q热相关性胆囊炎的管理及长期并发症仍有待确定。
我们描述了法国马蒂格的一例外科病例，该地为流行区，并对与Q热相关的伯氏考克斯体胆囊炎病例进行了系统综述。
纳入27例患者，其中3例（11.1%）为儿童。所有病例均在急性Q热期间报告，1例（3.7%）随后出现复发性胰腺炎和慢性胆囊炎。2例（2/2，100%）经胆囊PCR检测阳性证实，但所有病例免疫组化均为阴性。仅3例（11.1%）有结石。伯氏考克斯体胆囊炎是非典型的，因为它是无结石性的，伴有流感样综合征、狼疮抗凝物、抗心磷脂抗体和血小板减少。
血液和胆囊活检的血清学及PCR检测是伯氏考克斯体胆囊炎病因诊断的关键。怀疑存在炎症和/或自身免疫机制。多西环素仍是一线治疗药物。未来的前瞻性研究应确定多西环素和羟氯喹治疗能否预防最初出现抗磷脂抗体患者的疾病慢性进展。
