Familial Mediterranean fever with massive recurrent ascites: a case report

A 35-year-old woman had a history of recurrent massive ascites for 12 years. She had been examined to identify the etiology of ascites and was placed on antituberculous and subsequently steroid treatment at another center before admission to our hospital for fever, abdominal distention and abdominal pain. She had massive ascites with serum-ascites albumin gradient of 1.0 g/dl. We could not find any cause for ascites including tuberculosis. We thus performed exploratory laparotomy of the abdomen. There was no evidence of tuberculosis, peritoneal diseases or of any gynecological reason for ascites. Biopsies taken from the peritoneum revealed fibrinous peritonitis. Since she had a history of attacks of abdominal pain in her childhood, she was screened for mutations causing familial Mediterranean fever and was found to be homozygous for M694V. After definitive diagnosis of familial Mediterranean fever, she was put on colchicine treatment and relief of symptoms and reduction in ascites were seen on follow-up. To our knowledge this is the first documented case of massive ascites due to familial Mediterranean fever.