A 76-year-old man was referred to the Emergency Department because of collapse, epigastric pain and nausea. The patient had been diagnosed with an infrarenal aneurysm of the abdominal aorta nine years earlier. His symptoms were attributed to an aortic-duodenal fistula originating from the aneurysm. The patient died despite placement of an aortic prosthesis. A hospital screening programme for chronic Q fever in patients with aortic aneurysm revealed chronic Q fever. Until recently, vascular infection with Coxiella burnetii was an unknown disease in the Netherlands. In view of the nonspecific clinical presentation, severity and therapeutic consequences of the disease, we advise screening for chronic Q fever in all symptomatic patients with an aortic aneurysm or prosthesis - whether or not with aspecific symptoms - in regions where the disease is endemic.