| Summary: | Background: Q fever is a zoonotic disease produced by infection with Coxiella burnetii which can cause cardiovascular complications such as endocarditis, aneurysms, and vascular graft infections but is uncommon in the absence of exposure to animal reservoirs. Case summary: We present a case of a 64-year-old patient with chronic Q fever infection of an aortic endograft resulting in aorto-enteric fistula. Exposure history reported a recent travel to Mexico and no contact with animals during the stay. Vascular endograft explant was performed and intraoperative findings revealed an abscess cavity along the right anterior abdominal aorta and an aorto-enteric fistula. Extended course doxycycline and hydroxychloroquine were initiated. Due to the diagnostic challenge, we focused on preventing sepsis progression and exposure mitigation to the surgical team. Conclusion: We highlight the atypical presentation of a Q fever aneurysm, outcomes and possible delayed sequelae. A timely diagnosis and high clinical suspicion are paramount to reduce morbidity rate.
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