Here, we present the case of a 15-year-old Saudi male with a history of cardiac interventions who initially presented with persistent fever. The patient's complex medical history, including cardiac procedures and recent antibiotic use, added layers to the diagnostic challenge. Despite initial empirical antibiotic therapy, persistent fever prompted further investigations, leading to the identification of vegetation causing right ventricular outflow tract obstruction. Coxiella burnetii serology confirmed Q fever infective endocarditis. Tailored antimicrobial therapy, including doxycycline, ciprofloxacin, and hydroxychloroquine, resulted in clinical improvement. During the last visit, he remained well, with a painless rash resolved. His parents were satisfied with the progress. Ongoing antimicrobial therapy, periodic ophthalmology assessments, and potential surgical interventions were planned.
Keywords: coxiella burnetii; doxycycline; endocarditis; hydroxychloroquine; q fever.
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