Fever of unknown origin due to Coxiella burnetii, an unexpected guest in primary sclerosing cholangitis

A 64-year-old man with primary sclerosing cholangitis (PSC) was admitted for remitted fever and mild elevation (x1.5UNL) of transaminases and of alkaline phosphatase (x1.2UNL), with neither jaundice nor pruritus. He had history of hypertension and was active smoker (Fig 1A). A fleeting cutaneous eruption appeared at his legs and disappeared spontaneously in a few hours. No abdominal pain was recorded.