Associated with FUO Discussion

Hepatic granulomas can be caused by a varietyof conditions. Some of these causes associate with fever of unknown origin. For this reason, liver biopsy is one of the invasive procedures to evaluate a patient with FUO, especially when there are abnormalities in LFTs (1). The results of liver biopsy may provide histologic evidence of the specific etiology (such as caseation of TB). However, the morphologic patterns are often nonspecific and diagnosis must be pursued with appropriate studies (culture, skin test, laboratory tests, x-rays). Our patient was admitted due to prolonged fever and abnormalities in Alk-P and aminotransferases, also liver biopsy showed hepatic granulomas scattered in the lobule. We discuss causes of hepatic granulomas that are associated with fever of unknown origin. Differential Diagnosis Brucellosis: Brucellosis is a systemic infection in which liver can be involved. The species abortus, melitensis, suis and to a lesser extent, canis are the predominant causes of the disease in humans and animals. Different pathologic findings can be seen in brucella hepatitis. Brucella abortus is the most common species that can cause hepatic granulomas. The granulomas in brucellosis tend to be in lobule rather than confined to the periportal area.(2) Iran is an endemic area for brucellosis and the presence of prolonged fever, night sweats and fatigue in a patient raises the possibility of brucellosis. However, serologic tests for brucellosis were negative and blood cultures after 3 weeks were sterile. Thus, it seems that is an unlikely diagnosis for this case. Syphilis One of the unusual manifestations of secondary syphilis is hepatitis. It is characterized by high Alk-P and mild elevated bilirubin. Hepatic granuloma