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The expanded clinical spectrum of familial Mediterranean fever
Z Birsin Ozçakar1, Fatoş Yalçinkaya, Selçuk Yüksel
1Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Abstract:
The classical clinical features of familial Mediterranean fever (FMF) are recurrent self-limited attacks of fever and serositis. Amyloidosis of the AA type is the major complication of the disease. The diagnosis of FMF is still based on a history of typical acute attacks, ethnic background, and frequently, notable family history. Together with the discovery of MEFV gene, the clinical criteria for the diagnosis of the disease did not change. Although we have learned a great deal about the clinical features and the pathogenesis of FMF in the past few years, many atypical cases emerge, and caution should be exercised during diagnosis. In this report, we present three FMF patients not fulfilling clinical criteria for the diagnosis, discuss rare and unusual presentations of the disease, and emphasize the role of genetic analysis in these suspicious cases.
Insights
Familial Mediterranean fever (FMF) diagnosis can be challenging due to atypical presentations. Genetic analysis is crucial for identifying FMF in patients who don't meet standard clinical criteria, especially with unusual symptoms.
Area of Science:
- Genetics
- Internal Medicine
- Rheumatology
Background:
- Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever and serositis.
- AA type amyloidosis is a significant complication, impacting long-term prognosis.
- Current FMF diagnosis relies on clinical criteria, family history, and ethnic background.
Observation:
- Classical FMF diagnostic criteria may not encompass all disease presentations.
- Atypical FMF cases present diagnostic challenges, necessitating careful evaluation.
- This report details three FMF patients lacking typical clinical features.
Findings:
- Genetic analysis plays a vital role in diagnosing FMF, particularly in atypical cases.
- The discovery of the MEFV gene has advanced understanding but not altered clinical diagnostic criteria.
- Unusual FMF presentations require a high index of suspicion and genetic confirmation.
Implications:
- Emphasizes the importance of genetic testing for FMF diagnosis beyond established clinical guidelines.
- Highlights the need for vigilance in recognizing rare and unusual FMF manifestations.
- Suggests that genetic analysis should be considered for suspected FMF cases with atypical clinical profiles.
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