This document summarizes a case report of a rare case of idiopathic granulomatous hepatitis presenting as fever of unknown origin. A 41-year-old male presented with fever and elevated liver enzymes. Extensive testing ruled out known causes of fever and hepatitis. Liver and bone marrow biopsies found non-necrotizing granulomas. He was diagnosed with idiopathic granulomatous hepatitis and his fever resolved without treatment. Granulomatous lesions can be found in the liver from infections, medications, or idiopathically. Idiopathic granulomatous hepatitis should be considered a rare cause of fever of unknown origin.