Familial Mediterranean Fever Presenting with Recurrent Abdominal Pain without Periodic Fever Following COVID-19.
Nobuhiro Ueno, Hiromichi Sugai, Suzumi Ujiie et al.
✦ AI-curated · Sources linked
Case in brief
A 16-year-old girl developed recurrent abdominal pain without fever after COVID-19. Initial evaluation, including endoscopy, was unremarkable apart from mildly elevated fecal calprotectin (182.1 μg/g). At readmission, she had peritoneal signs, mild pleural effusion, and elevated serum amyloid A (113.9 mg/L), despite a normal C-reactive protein level. Colchicine promptly suppressed the attacks, and fecal calprotectin and serum amyloid A normalized within one month. MEFV sequencing showed a homozygous E148Q mutation, supporting a diagnosis of atypical familial Mediterranean fever.
What made this case unusual
The presentation lacked periodic fever, and C-reactive protein remained normal despite peritoneal signs and elevated serum amyloid A.
Diagnostic / clinical pearl
Familial Mediterranean fever should be considered in recurrent post-infectious abdominal pain even without fever; serum amyloid A and MEFV sequencing may support diagnosis when routine evaluation is unrevealing.