Granulomatous hepatitis accompanying a self-limited febrile disease

Idiopathic granulomatosis manifesting as fever of unknown origin

Twenty patients with fever of unknown origin were found to have idiopathic granulomatosis of the liver, lymph nodes, spleen, or bone marrow. At the time of initial examination, these patients had persistent or recurrent fever and pronounced constitutional symptoms but few physical findings. The most common laboratory abnormalities were increased erythrocyte sedimentation rate in 18, abnormal results of liver function tests in 12, anemia in 11, and hypergammaglobulinemia in 10. Of the 20 patients, 14 required corticosteroids at the beginning of the illness for control of symptoms, especially fever. After 5 to 10 years of follow-up, an alternative diagnosis had been established in 5 of the 20 patients. Of the remaining 15 patients with fever and idiopathic granulomatosis, 6 are still receiving corticosteroids. Corticosteroid treatment did not result in progression or dissemination of an unrecognized infection. No clinical or laboratory abnormality helped to predict the need for long-term corticosteroid treatment.

Bacteremia caused by CDC group Ve-1 in previously healthy patient with granulomatous hepatitis

This is a case report of CDC group Ve-1 bacteremia in an otherwise healthy patient with granulomatous hepatitis.

Liver granulomas and allopurinol

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Chronic granulomatous hepatitis

Three cases are described in which a chronic relapsing febrile illness was associated with granulomas in the liver. None of the known causes of hepatic granulomas was present in these patients. In two cases there was clinical improvement after corticosteroid treatment and this was associated with resolution of the histological changes on liver biopsy. These three cases support the concept that chronic granulomatous hepatitis of unknown aetiology is a distinct entity.

Granulomas of the liver

The authors personally studied 138 patients with liver granulomas: seventy-five (54%) had sarcoidosis, twenty-six (19%) had primary biliary cirrhosis, twenty-three (17%) had miscellaneous recognizable disorders and fourteen (10%) were undiagnosed. The modes of presentation, the clinical, biochemical and radiological features are compared, and the course of each disease is followed. The undiagnosed group were frequently middle-aged men presenting with abdominal pain, fever and hepato-splenomegaly. The unsatisfactory term granulomatous hepatitis, if used, should be reserved for this undiagnosed residue until follow-up reveals a more definite aetiology.

Syndromes of infectious mononucleosis

Physicians are becoming more aware of the existence and diversity of the infec tious-mononucleosislike responses which patients may develop in certain circum stances. Differentiation and identification call for knowledgable familiarity with these various clinical-hematologic responses.