Chronic infection with Coxiella burnetii, the pathogen responsible for Q fever, presents considerable diagnostic and treatment difficulties, especially in individuals with implanted devices like left ventricular assist devices (LVADs). We describe the case of a 28-year-old man with an LVAD who experienced persistent fever, weight loss, night sweats, and a productive cough. Blood and sputum cultures returned negative, and transthoracic echocardiography did not indicate endocarditis. Nevertheless, serological tests showed elevated levels of C. burnetii immunoglobulin G Phase I antibodies, and positron emission tomography-computed tomography revealed increased metabolic uptake at the aortic insertion site of the LVAD. The initial therapy of doxycycline and hydroxychloroquine was switched to doxycycline and moxifloxacin due to recurrent fever. After more than 18 months of monitoring, the patient remained symptom-free with reduced inflammatory markers. This case highlights the need to consider Q fever in LVAD patients with prolonged fever, particularly those with animal-related occupational exposure, and emphasizes the diagnostic and therapeutic challenges of chronic C. burnetii infection in this group.