The management of an endograft infection with Coxiella burnetti (Q fever) is presented. In this case report, we describe a unique case of an endovascular aneurysm repair (EVAR) that was originally placed for a 6.4-cm abdominal aortic aneurysm with an aorto-left renal vein fistula. In retrospect, the abdominal aortic aneurysm was most likely infected at the time of EVAR. The patient presented 2 years later with a virulent infection of the stent graft requiring explantation and reconstruction. This case highlights surgical management of an infected EVAR with homograft reconstruction and subsequent antibiotic management.