GRANULOMATOUS HEPATITIS IN 3 CHILDREN DUE TO CAT-SCRATCH DISEASE WITHOUT PERIPHERAL ADENOPATHY - AN UNRECOGNIZED CAUSE OF FEVER OF UNKNOWN ORIGIN

Objective.-To report the clinical experience of three patients with fe ver of unknown origin ultimately diagnosed as having cat-scratch granu lomatous hepatitis in the absence of peripheral adenopathy. Design.-Ca se-control study. Setting.-Referral center at university-based referra l practice. Patients.-Three children with fever of unknown origin. Fol low-up following presentation was 6 months for each patient. Measureme nt and Results.-All three patients with fever of unknown origin were d iagnosed radiographically to have multiple hepatic defects. The defect s were shown histologically to be granulomatous. Two of the three pati ents had Warthin-Starry staining bacilli in the granulomas consistent with a diagnosis of Afipia felis. All three had positive cat-scratch s kin test results. Conclusions.-Cat-scratch disease in the absence of p eripheral adenopathy is a heretofore unrecognized cause of fever of un determined origin and may account for a small, but significant, percen tage of children presenting with it.