ABSTRACT
A frequent form of presentation of unexplained fever is in association with tender or nontender hepatic enlargement. Most forms of viral hepatitis as well many bacterial infections of the liver may present with tender hepatomegaly and fever. Infections outside the hepatobiliary tree, especially in infants and occasionally in adults may cause jaundice, in addition to fever. The principal methods of liver biopsy are blind percutaneous needle puncture, imaging-guided, transjugular, laparoscopy-directed, and operative wedge biopsy. Liver biopsy reveals a histologic picture similar to that of viral hepatitis. Certain rickettsial diseases may occasionally present with fever and hepatic dysfunction. Various spirochetes may involve the liver primarily or secondarily such as Borrelia, Leptospira, and Treponema pallidum. Liver biopsy demonstrates malarial pigment, increased Kupffer cell activity, granulomatous lesions and hepatocyte necrosis. Unexplained fever due to liver metastases most frequently arises in cases of cancer of the pancreas and gastrointestinal tract, breast, melanoma, or unknown primary.
