Granulomatous hepatitis (GH) is a subset of chronic hepatitis in which the predominant inflammatory infiltrate consists of macrophages. It can be associated with systemic granulomatous disease or confined to the liver. When associated with systemic disease, infectious causes (bacterial, fungal, protozoal, or metazoan) are more common, while disease confined to the liver is often idiopathic. Dogs with idiopathic GH most often present acutely ill, with fever, high white blood cell counts, and with ultrasound finding of a large liver often with nodules and characteristic hyperechoic parenchymal bands.