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Published on: September 22, 2019
Familial Mediterranean fever with sigmoid colon stricture
Yuki Yamamoto1, Akira Madarame2, Masakatsu Fukuzawa1
1Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Abstract:
We describe a case of familial Mediterranean fever (FMF) with sigmoid colon stricture. The patient, a woman in her 30 s, had a 12-year history of ileocolitis-type Crohn's disease. The colonoscope could not pass because of the sigmoid colon stricture, and the patient was referred to our hospital with complaints of abdominal pain and fever. At 2-month postreferral, the patient presented with severe abdominal pain and fever. Computed tomography and intestinal ultrasonography revealed no bowel obstruction, whereas wall thickening was observed in the sigmoid colon and small bowel. Our medical interview revealed a cyclical nature to the symptoms. We diagnosed FMF and initiated colchicine. Subsequently, for more than 2 years, the patient remained asymptomatic, and the sigmoid colon stricture improved. FMF should be considered in patients with inflammatory bowel disease with periodic abdominal pain and fever.
Insights
Familial Mediterranean fever (FMF) can mimic inflammatory bowel disease symptoms. Early diagnosis and colchicine treatment resolved a patient's sigmoid colon stricture and periodic abdominal pain, highlighting FMF as a crucial differential diagnosis.
Area of Science:
- Gastroenterology
- Rheumatology
- Internal Medicine
Background:
- Inflammatory bowel disease (IBD) and familial Mediterranean fever (FMF) share overlapping symptoms like abdominal pain and fever.
- Sigmoid colon strictures are a known complication of chronic IBD, potentially complicating diagnosis.
Purpose of the Study:
- To report a case of familial Mediterranean fever (FMF) presenting with sigmoid colon stricture in a patient with a history of Crohn's disease.
- To emphasize the importance of considering FMF in IBD patients with cyclical abdominal pain and fever.
Main Methods:
- Case report of a woman in her 30s with a 12-year history of ileocolitis-type Crohn's disease.
- Diagnostic workup included colonoscopy, computed tomography (CT), and intestinal ultrasonography.
- Clinical interview focusing on cyclical symptom patterns.
Main Results:
- The patient presented with severe abdominal pain and fever, with imaging showing sigmoid colon wall thickening but no obstruction.
- Diagnosis of FMF was established based on cyclical symptoms.
- Initiation of colchicine treatment led to a sustained asymptomatic period of over 2 years and improvement of the sigmoid colon stricture.
Conclusions:
- Familial Mediterranean fever (FMF) should be considered in the differential diagnosis of inflammatory bowel disease (IBD) patients experiencing periodic abdominal pain and fever.
- Colchicine therapy can be effective in managing FMF, even in the presence of IBD-related complications like sigmoid colon stricture.
- This case underscores the diagnostic challenge and successful management of a rare presentation of FMF.
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