Subclinical inflammation in a case of menstruation-induced familial Mediterranean fever: A case report.

Abstract

RATIONALE:

Because most patients with familial Mediterranean fever (FMF) have attacks without any prodromal symptoms, and since it is suggested that patients with FMF have subclinical inflammation even during remission, a daily continuous administration of colchicine is recommended for patients with FMF even during remission. However, it is possible that intermittent colchicine therapy only during FMF attacks prevents the attacks completely in patients with FMF with expectable attacks.

PATIENT CONCERNS:

A 31-year-old Japanese woman suffered high fever and arthralgia lasting for 2 to 3 days after each menstrual period's start. She was admitted to our hospital, and colchicine was administered immediately after her next period's start, and the febrile attack was completely prevented.

DIAGNOSES:

We eventually diagnosed typical FMF.

INTERVENTIONS:

Her remission has been maintained by intermittent colchicine therapy.

OUTCOMES:

The genetic analysis revealed the G304R heterozygous mutation in exon 2 of the MEFV gene. Cytokine analysis suggested subclinical inflammation during the remission period.

LESSONS:

This case suggests that taking an extensive medical history (including the relationship between fever attack and menstruation) is important in the diagnosis of female patients with FMF. This case also suggests that a continuous administration of colchicine may have to be considered to regulate subclinical inflammation even in patients with FMF with completely expectable attacks.

• Authors: Kazusato Hara, Yushiro Endo, Midori Ishida, Yuya Fujita, Sosuke Tsuji, Ayuko Takatani, Toshimasa Shimizu, Remi Sumiyoshi, Takashi Igawa, Masataka Umeda, Shoichi Fukui, Ayako Nishino, Shin-Ya Kawashiri, Naoki Iwamoto, Kunihiro Ichinose, Mami Tamai, Hideki Nakamura, Tomoki Origuchi, Kiyoshi Migita, Atsushi Kawakami, Tomohiro Koga
• Journal: Medicine (Medicine (Baltimore)) Vol. 97 Issue 38 Pg. e12305 (Sep 2018) ISSN: 1536-5964 [Electronic] United States
• PMID: 30235678 (Publication Type: Case Reports, Journal Article)

Chemical References

• MEFV protein, human
• Pyrin
• Tubulin Modulators
• Colchicine

Topics

• Adult
• Arthralgia (etiology)
• Colchicine (administration & dosage, therapeutic use)
• Drug Administration Schedule
• Familial Mediterranean Fever (complications, drug therapy, physiopathology)
• Female
• Fever (etiology)
• Humans
• Inflammation (physiopathology)
• Menstruation (physiology)
• Mutation
• Pyrin (genetics)
• Remission Induction
• Tubulin Modulators (administration & dosage, therapeutic use)