Transient and Recurrent Pulmonary Infiltrations Associated with Familial Mediterranean Fever

Area of Science:

• Rheumatology
• Pulmonology
• Genetics

Background:

• Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent episodes of fever and serositis.
• Pulmonary manifestations of FMF are uncommon, with serositis (pleuritis, pericarditis) being more frequent than direct lung parenchymal involvement.
• Chest symptoms like pleural effusion and chest pain in FMF can be misdiagnosed as infectious conditions such as pneumonia.

Observation:

• A 67-year-old male presented with recurrent, transient anterior chest pain.
• Imaging revealed pericardial effusion, bilateral pleural effusion, and bilateral lower lung lobe infiltrates.
• The patient's symptoms and imaging findings improved rapidly with colchicine treatment alone, without antibiotics.

Findings:

• The clinical presentation of pericarditis, pleurisy, and pulmonary infiltrates, along with the positive response to colchicine, strongly suggested FMF.
• This case highlights that pulmonary infiltrates can be a manifestation of FMF, albeit rare.

Implications:

• Clinicians should consider FMF in the differential diagnosis of patients presenting with recurrent pulmonary infiltrates, especially when accompanied by other signs of serositis.
• Prompt diagnosis and treatment with colchicine can effectively manage FMF-related pulmonary involvement and prevent misdiagnosis as infectious pneumonia.
• This case underscores the importance of recognizing the diverse clinical spectrum of FMF, including its less common pulmonary manifestations.