A case of Q fever with hepatitis and an atypical skin lesion

A 60-year-old male patient presented at the emergency department with a 2-week history of general malaise with high fever (till 39°C), anorexia and nausea. Since 2 weeks a small non-healing wound, following shaving, was noticed by the patient on the right cheek. His past medical history was unremarkable. He used alcohol on a daily basis, on average 4 units a day, and smoked. He took no medications. 1 Month before presentation he travelled to the south of France. Clinical examination was normal except for a small rather atonic ulcer on his right cheek