Idiopathic Granulomatous Hepatitis Presented as Fever of Unknown Origin

Granulomatous hepatitis is a well-known cause of fever of unknown origin [1, 2, 3]. This syndrome is characterized by hepatic granulomas and nonspecific flu-like symptoms, fever, and weight loss, or by asymptomatic liver function abnormalities [4]. Most common causes include viral hepatitis, Mycobacterial infections, Q fever and histoplasmosis. Certain malignancies e. g. lymphomas and drugs/ toxins are also associated with the development of granulomatous hepatitis. Recent studies have shown that in 5-30 of cases, granulomatous hepatitis is idiopathic with no obvious secondary cause [5]. Steroids are very safe and effective for symptomatic treatment in most cases. Moreover, in some cases, like ours, long-term steroid treatment is needed [6].