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Q Fever masquerading as prostate cancer metastases.

We report a case of Q fever demonstrated on (99m)Tc methylene diphosphonate bone scan and fluorodeoxyglucose (FDG) PET/CT. A 66-year-old man with newly diagnosed, low-grade prostate cancer presented with abdominal and bone pain. Bone scan revealed multiple lesions suspicious for prostate cancer metastases. Because of liver abnormalities on noncontrast CT, an FDG PET/CT was performed and demonstrated FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy. This appearance, thought unusual for low-grade prostate cancer, prompted extensive clinical evaluation for several months. Liver and iliac bone biopsies showed noncaseating granulomas without neoplasia. Extensive serologic evaluation eventually demonstrated elevated Q fever titers.