{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T21:27:13Z","timestamp":1773782833261,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":295,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Infectious Diseases"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Q fever is a globally distributed zoonotic infection caused by\n                      <jats:italic>Coxiella burnetii<\/jats:italic>\n                      , exhibiting a broad clinical spectrum in both acute and chronic forms. While pneumonia, hepatitis, and endocarditis are well\u2010recognized manifestations, cutaneous involvement remains poorly characterized and likely underreported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 63\u2010year\u2010old male metalworker was admitted with a 2\u2010week history of high\u2010grade fever, dyspnea, anorexia, intractable hiccups, and profound asthenia. Physical examination revealed a diffuse, nonpruritic, blanchable macular rash on the back and sacral region. Extensive microbiological and autoimmune investigations were negative. Chest imaging demonstrated bilateral pneumonia, mediastinal lymphadenopathy, and a small pericardial effusion. Skin biopsy showed mild acanthosis, dermal capillary congestion, and superficial lymphohistiocytic infiltrates. Serological testing confirmed acute Q fever, with elevated Phase II\n                      <jats:italic>C. burnetii<\/jats:italic>\n                      antibody titers. Oral doxycycline led to complete resolution of fever and rash. Serial serology demonstrated a progressive decline in antibody titers, and the patient remained symptom\u2010free after 6\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights a rare parainfectious macular rash associated with acute Q fever\u2014apparently the first reported in Italy. Cutaneous involvement in Q fever may represent a parainfectious immune\u2010mediated reaction. Its nonspecific appearance and lack of a characteristic distribution pattern often delay diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Clinicians should maintain a high index of suspicion for\n                      <jats:italic>C. burnetii<\/jats:italic>\n                      infection in patients with unexplained fever, pneumonia, and rash, even in the absence of direct animal exposure. Multidisciplinary evaluation and serial serology are pivotal for timely diagnosis, effective management, and monitoring of disease resolution.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crdi\/9263690","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:35:09Z","timestamp":1761219309000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Macular Rash as a Presenting Symptom of Acute Q Fever: A Case Report"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0926-5457","authenticated-orcid":false,"given":"Muhammad Ali","family":"Muslimani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5898-6448","authenticated-orcid":false,"given":"Valeria","family":"Brazzelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6244-3646","authenticated-orcid":false,"given":"Marco","family":"Lucioni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-1544","authenticated-orcid":false,"given":"Angela Maria","family":"Di Matteo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0235-9207","authenticated-orcid":false,"given":"Raffaele","family":"Bruno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8437-6627","authenticated-orcid":false,"given":"Enrico","family":"Brunetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"e_1_2_10_1_2","first-page":"183","article-title":"Q Fever as a Biological Weapon","volume":"18","author":"Kagawa F. 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