Excisionallymph node biopsy in macroscopic study showed a big lymph node with complete capsule.Inside of lymph node was a whitish-pink colour. In microscopic evaluation of lymph nodt massive necrosis with coagulation tracing were seen.Lymph node aspiration culture and smear were negative. No acid fast Bacilli were found. So thl preparation was compatible with Kikuchi disease.The pathology of Kikuchi disease is necrotizing lymphadenitis without presence of PMN am usually necrotic tissue are infiltrated with transformed T.lymphocytes. The etiology of Kikuchi disseat is not clearly. known. It may be a SLE like disease with characteristics of autoimmune disease.

For patient, assay of hydrogen peroxide production (Nitroblue tetrazolium reduction) was done, and NBT test was positive. So diagnosis of chronic granulomatous disease (CGD) confirmed. Cephalotin therapy continued, gingivostomatitis subsided, fever and headache disappeared and patient with prophylactic dosage of co-trimoxazol discharged.CGD of childhood is a rare group of inherited disorders phagocytic cells (6) characterized clinically by recurrent life-threatening infections and excessive granuloma formation.Phagocytosis and migration of phagocytes are normal, but killing of microorganisms because of defective of hydrogen peroxide, is impaired (1,2,6). The current mortality rate is 2-5 percent per year. Patients with CGD in the absence of antibiotic proplylaxis have severed infections due to catalase + tive bacteria and fungi about once a year (6), but proplylaxis with co-trimoxazole reduces. The incidence of serious bacterial infection to about one every four years (6) interferon gamma prophylaxis has reduced bacterial infections by an additional 70 percent (6).Fungal infestations in spite of antibiotic and gamma interferon proplylaxis remain a major problem with an incidence of approximately 0.1 infection per patients per year (6). Although these patients are already somewhat immunocompromised, the judicious use of corticosteroids in conjunction with antibiotics has been (1) successful in opening and maintaining the patency of hollow visci in patients with CGD (4,5).

Serologic tests for salmonella and brucella were negative. Peripheral blood morphology and liver enzymes were at normal level. Platelate 150000, PT 14.Regarding clinical feature and contact with sheep and regarding to nose-bleeding, intestinal hemorrhages, hematuria, dermal echimosis. The diagnosis was consistent with viral hemorrhagic fevers, fulminant hepatitis, leptospirosis, toxic salmonella infection, gram negative septic syndrome and…But regarding to initial septic syndrome, and profound cytopenia, continuous contact with blood of sheep and regarding to report of some cases of CCHF in Esfahan, Guilan and Tehran, serologic (Elisa) tests for CCHF was requested (Pasteur Institute, Tehran) and it was positive. Confirmative test for CCHF from Center of Arboviruses Researches in Senegal was positive. The patient's clinical situation after five days hospitalization was much better. IV antibiotic and other drugs were switched to oral route and he was discharged and asked him to comeback to outpatient clinic, for more evaluation.