Q Fever, CNS Vasculitis, and Stroke: A Case Report

A 43-year-old male pet shop owner on leflunomide for seronegative rheumatoid arthritis presented locally with strange behavior and aphasia, preceded by flu-like symptoms and high fevers. Initial workup revealed cerebrospinal fluid lymphocytic pleocytosis (22 cells, 74% lymphocytes), for which he was started on empiric antimicrobial therapy. Magnetic resonance imaging of the brain revealed extensive, bilateral ischemic strokes (Figure). A transesophageal echocardiogram was negative. He was then transferred to our institution for further evaluation.