Study flowchart.^aA patient with unexplained elevated serology was considered unexplored if he did not have transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and PET scan. ^bSeventy-six-year-old man with phase 1 IgG at 25 600 2 years after an acute Q fever living in an endemic area (La Rochelle, region of Poitou Charente). TTE and TEE were normal. PET scan was considered as normal by local practitioner. Second look by S.C. at our center found hyperfixation of subclavian arteries predominant right. Combination therapy with doxycycline and hydroxychloroquine resulted in a dramatic serology decrease. ^cOsteomyelitis of the pubic symphysis. ^dLung fibrosis (n = 5), lung pseudotumor, giant cell arteritis, chorioretinitis, and chronic hepatitis (1 case each).