A Case of Familial Mediterranean Fever Undiagnosed for 15 Years for which Three Operations were Performed for Recurrent Episodes of Abdominal Pain

Abstract

The patient was a 30-year-old woman complaining of abdominal pain. There was a 15-year history of abdominal pain accompanied by fever, and it had been treated conservatively as peritonitis. Appendectomy was performed 12 years, and resection of the allantoic duct residual was performed two years previously, however, abdominal pain attack persisted. Upon recent episode of abdominal pain, rise in mild inflammatory findings and wall thickening of the jejunum were observed with CT. But no abnormalities that caused abdominal pain were observed in US, MRI, GFS and CF. However, abdominal pain developed about once a month. We introduced her to the Departments of Gastroenterology and Obstetrics and Gynecology, but they recommended to follow up her clinical course. Exploratory laparoscopy and capsule endoscopy revealed no abnormalities. A possibility of familial Mediterranean fever was suggested at 1 year and 8 months from the first visit, and the final diagnosis of familial Mediterranean fever was made with mutation in the MEFV gene by a genetic analysis. After the diagnosis, abdominal pain has not developed at all with prophylactic administration of colchicine. We inferred that she had suffered from undiagnosed familial Mediterranean fever for 15 years. Although this disease is extremely rare, it seems necessary to keep this disease in mind with recurrent episodes of fever and abdominal pain of unknown cause.