Late-onset-case of Familial Mediterranean fever (FMF)-exotic but rising differential diagnosis of "unclear abdominal illness" in Germany due to increasing migration over the past decade.
M R Kanaan, F Meyer
✦ AI-curated · Sources linked
Case in brief
A 19-year-old man of Syrian origin presented with acute right lower-quadrant pain, fever, arthralgia and pleuritic chest pain, with similar episodes previously resolving spontaneously. Examination showed peritonism; CRP was 35 mg/L, while the white blood cell count was normal. Ultrasound excluded appendicitis, and symptoms resolved fully within 2 days with fluids, analgesia and dietary rest. Further history revealed parental consanguinity and a relative with similar symptoms. FMF was diagnosed using the Tel Hashomer criteria, despite no definitive serositis or genetic confirmation at treatment initiation, and colchicine 1.0 mg/day was started.
What made this case unusual
The diagnostic clue emerged from a detailed family history after the acute episode had resolved; the diagnosis was made clinically without genetic confirmation or definitive serositis.
Diagnostic / clinical pearl
In recurrent febrile abdominal episodes, a careful family history—including consanguinity and relatives with similar attacks—can support consideration of FMF even when genetic confirmation is unavailable.
Why it matters
The report highlights FMF as a differential diagnosis for recurrent acute abdominal presentations in nonendemic settings and cautions against unnecessary CT imaging in a compatible clinical context.