[Familial Mediterranean fever (familial paraoxysmal polyserositis)]

A 48-year-old Iranian man had suffered since the age of 15 from repetitive periods of fever and abdominal pain, which had led to appendicectomy and cholecystectomy. He was admitted because of pain in the left chest and fever. He showed himself to be a personality fixed on his chronic pain. He reported pressure in the left chest and slight tenderness in the abdomen. His body temperature was about 38.5 degrees C axillary.

All routine laboratory tests were normal except CRP (183 mg/l), microalbuminuria (20 mg/l) and amyloid A-protein in serum (865 mg/l). In an X-ray of the chest a small amount of fluid was seen on both sides. A gene test confirmed mutation of the Marenostrin/Pyrin gene at chromosome 16.

The diagnosis of familial Mediterranean fever was based on the typical clinical history, the ethnographical background and the result of the gene test. We initiated therapy with colchicine (3 x 0.5 mg/d) that resulted in rapid improvement of the symptoms and the patient has had no further pain.

Mediterranean fever should be considered in cases of repeated periods of abdominal or chest pain and fever in patients with typical ethnographical background. An early diagnosis and therapy may shorten the course of the disease and prevent unnecessary surgery, prolonged periods of hospitalization, a personality structure fixed on chronic pain, and the development of amyloidosis.