Granulomatous hepatitis in three children due to cat-scratch disease without peripheral adenopathy. An unrecognized cause of fever of unknown origin
J. J. Malatack and R. Jaffe
Section of General Pediatrics, St Christopher's Hospital for Children, Temple University School of Medicine, Philadelphia, PA 19134-1095.
OBJECTIVE--To report the clinical experience of three patients with fever
of unknown origin ultimately diagnosed as having cat-scratch granulomatous
hepatitis in the absence of peripheral adenopathy. DESIGN--Case-control
study. SETTING--Referral center at university-based referral practice.
PATIENTS--Three children with fever of unknown origin. Follow-up following
presentation was 6 months for each patient. MEASUREMENT AND RESULTS--All
three patients with fever of unknown origin were diagnosed radiographically
to have multiple hepatic defects. The defects were shown histologically to
be granulomatous. Two of the three patients had Warthin-Starry staining
bacilli in the granulomas consistent with a diagnosis of Afipia felis. All
three had positive cat-scratch skin test results. CONCLUSIONS--Cat-scratch
disease in the absence of peripheral adenopathy is a heretofore
unrecognized cause of fever of undetermined origin and may account for a
small, but significant, percentage of children presenting with it.
