This case report describes a patient with a mild form of familial Mediterranean fever (FMF) associated with a polymorphism in the MEFV gene. The patient experienced recurrent fever episodes accompanied by mild skin rashes and joint pain. Genetic testing identified a c.1588-69G>A polymorphism in intron 5 of the MEFV gene. The patient responded well to treatment with corticosteroids and colchicine, though had to discontinue colchicine due to side effects. The polymorphism is not rare and has been found in healthy subjects, suggesting it is associated with a milder form of FMF that requires other triggers to induce symptoms.
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...georgemarini
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...SarkarRenon
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation. Until now morethan 304 sequence variants have been recorded. Here, we describe a case of mild FMF confirmedby...
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...AnonIshanvi
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation. Until now morethan 304 sequence variants have been recorded. Here, we describe a case of mild FMF confirmedby...
Familial Mediterranean Fever (FMF) is an autoinfl ammatory disease caused by mutations in the MEFV
gene and characterized by recurrent fever, polyserositis and arthritis. It is transmitted in an autosomal
recessive pattern. FMF has been predominantly found in ethnic groups living around the Mediterranean
basin (Jews, Arabs, Turks, and Armenians). Although accompanying infl ammatory diseases have been
reported in FMF, the coexistance of fi bromyalgia syndrome (FMS) is very rare. MEFV gene analysis that the
fi rst patient had compound heterozygous mutation (M680I+V726A) and the other patient had heterozygous
mutation (M694V). This association will be discussed in this case report.
Familial Mediterranean Fever (FMF) is an autoinflammatory disease caused by mutations in the MEFV gene and characterized by recurrent fever, polyserositis and arthritis. It is transmitted in an autosomal recessive pattern. FMF has been predominantly found in ethnic groups living around the Mediterranean basin (Jews, Arabs, Turks, and Armenians).
This document discusses the genetic syndrome of Familial Mediterranean Fever (FMF). FMF is a rare autosomal recessive autoinflammatory disorder characterized by periodic fever attacks accompanied by symptoms like abdominal pain, skin rashes, and joint inflammation. It is caused by mutations in the MEFV gene which regulates inflammation. Treatment involves lifelong use of the drug colchicine to prevent attacks and reduce risk of secondary amyloidosis, a serious complication where amyloid proteins damage the kidneys. The document provides details on the pathogenesis, clinical presentation, diagnosis, and treatment of FMF.
Annals of Clinical and Medical Case Reports - Acmcasereportsemualkaira
This case report describes a 53-year-old woman who presented with chronic inflammatory low back pain and oligoarthritis. She was found to have a heterozygous M694V mutation in the MEFV gene, which is associated with Familial Mediterranean Fever (FMF). She reported a history of recurrent fever and abdominal pain episodes meeting criteria for FMF. Imaging showed sacroiliitis consistent with spondyloarthritis (SpA). The report discusses whether she has SpA associated with the MEFV mutation, or FMF with associated SpA, as MEFV mutations and SpA have been linked. It concludes both are possible explanations given the role of the IL-1 pathway in both disorders.
Atypical Presentation of Salmonella Typhi Blood Stream Infection in an Immuno...JapaneseJournalofGas
The genus Salmonella is an important enteric pathogen which carries high morbidity and mortality in many parts of the world [1, 2]. The serotypes of Salmonella enteric namely serovars Typhi, Paratyphi A, Paratyphi B and Paratyphi C are the causative agents of the enteric fever. Other serovars collectively called as Non Typhoidal Salmonella (NTS) mainly cause gastroenteritis
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...georgemarini
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...SarkarRenon
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation. Until now morethan 304 sequence variants have been recorded. Here, we describe a case of mild FMF confirmedby...
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...AnonIshanvi
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation. Until now morethan 304 sequence variants have been recorded. Here, we describe a case of mild FMF confirmedby...
Familial Mediterranean Fever (FMF) is an autoinfl ammatory disease caused by mutations in the MEFV
gene and characterized by recurrent fever, polyserositis and arthritis. It is transmitted in an autosomal
recessive pattern. FMF has been predominantly found in ethnic groups living around the Mediterranean
basin (Jews, Arabs, Turks, and Armenians). Although accompanying infl ammatory diseases have been
reported in FMF, the coexistance of fi bromyalgia syndrome (FMS) is very rare. MEFV gene analysis that the
fi rst patient had compound heterozygous mutation (M680I+V726A) and the other patient had heterozygous
mutation (M694V). This association will be discussed in this case report.
Familial Mediterranean Fever (FMF) is an autoinflammatory disease caused by mutations in the MEFV gene and characterized by recurrent fever, polyserositis and arthritis. It is transmitted in an autosomal recessive pattern. FMF has been predominantly found in ethnic groups living around the Mediterranean basin (Jews, Arabs, Turks, and Armenians).
This document discusses the genetic syndrome of Familial Mediterranean Fever (FMF). FMF is a rare autosomal recessive autoinflammatory disorder characterized by periodic fever attacks accompanied by symptoms like abdominal pain, skin rashes, and joint inflammation. It is caused by mutations in the MEFV gene which regulates inflammation. Treatment involves lifelong use of the drug colchicine to prevent attacks and reduce risk of secondary amyloidosis, a serious complication where amyloid proteins damage the kidneys. The document provides details on the pathogenesis, clinical presentation, diagnosis, and treatment of FMF.
Annals of Clinical and Medical Case Reports - Acmcasereportsemualkaira
This case report describes a 53-year-old woman who presented with chronic inflammatory low back pain and oligoarthritis. She was found to have a heterozygous M694V mutation in the MEFV gene, which is associated with Familial Mediterranean Fever (FMF). She reported a history of recurrent fever and abdominal pain episodes meeting criteria for FMF. Imaging showed sacroiliitis consistent with spondyloarthritis (SpA). The report discusses whether she has SpA associated with the MEFV mutation, or FMF with associated SpA, as MEFV mutations and SpA have been linked. It concludes both are possible explanations given the role of the IL-1 pathway in both disorders.
Atypical Presentation of Salmonella Typhi Blood Stream Infection in an Immuno...JapaneseJournalofGas
The genus Salmonella is an important enteric pathogen which carries high morbidity and mortality in many parts of the world [1, 2]. The serotypes of Salmonella enteric namely serovars Typhi, Paratyphi A, Paratyphi B and Paratyphi C are the causative agents of the enteric fever. Other serovars collectively called as Non Typhoidal Salmonella (NTS) mainly cause gastroenteritis
Atypical Presentation of Salmonella Typhi Blood Stream Infection in an Immuno...JohnJulie1
The genus Salmonella is an important enteric pathogen which carries high morbidity and mortality in many parts of the world [1, 2]. The serotypes of Salmonella enteric namely serovars Typhi, Paratyphi A, Paratyphi B and Paratyphi C are the causative agents of the enteric fever. Other serovars collectively called as Non Typhoidal Salmonella (NTS) mainly cause gastroenteritis
Colchicine failure in Familial Mediterranean Fever and potential alternatives...José Luis Moreno Garvayo
This document discusses a clinical trial testing the efficacy of anakinra (an interleukin-1β antagonist) for treating patients with familial Mediterranean fever (FMF) who are resistant or intolerant to colchicine treatment. FMF is a genetic autoinflammatory disease characterized by fever and inflammation. About 5-10% of FMF patients do not respond to standard colchicine treatment. Recent research suggests interleukin-1β plays a key role in FMF pathogenesis. Case reports have shown interleukin-1β blockade with drugs like anakinra can effectively treat colchicine-resistant FMF. The described clinical trial is the first double-blind randomized controlled trial testing anakinra for these patients. So
Familial Mediterranean Fever is an autosomal recessive disease characterized by recurrent fevers and inflammation localized to the peritoneum, pleura, joints, or skin. It is most common in people of Mediterranean descent and is caused by mutations in the MEFV gene. Symptoms include abdominal pain, fever, arthritis, and erysipelas-like lesions. If left untreated, it can lead to amyloidosis. Treatment involves lifelong colchicine to prevent inflammatory episodes and reduce amyloidosis risk. Some patients may be resistant to colchicine and require alternative treatments like interleukin-1 or tumor necrosis factor inhibitors.
This patient presented with fever, rash, ankle pain, and respiratory distress. Testing showed elevated inflammatory markers, thrombocytopenia, and hyperferritinemia. A bone marrow biopsy showed hemophagocytosis, consistent with macrophage activation syndrome (MAS). Treatment with steroids and cyclosporine improved the patient's condition and laboratory abnormalities. The underlying diagnosis is likely a rheumatic condition presenting with MAS.
Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
A 28-year-old woman with a history of ulcerative colitis presented with muscle weakness, myalgias, and constitutional symptoms. Tests found elevated muscle enzymes and inflammation on muscle biopsy. She was diagnosed with polymyositis, a rare extra-intestinal manifestation of ulcerative colitis. Treatment with steroids and azathioprine improved her symptoms. While disease activity is not required, extra-intestinal manifestations like polymyositis should be considered in ulcerative colitis patients with muscle symptoms. Both conditions responded well to immunosuppressive therapy.
Interleukin-1 targeting drugs in familial mediterranean fever: a case series ...José Luis Moreno Garvayo
Revisión de los artículos publicados que describen el uso de medicamentos cuyo objetivo es la interleucina-1 en el tratamiento de la fiebre mediterránea familiar. Se describen siete casos en todos los cuales el uso de estos medicamentos fue beneficioso.
Clinical Case of Post-Vaccination Measles Followed By Severe Neutropeniainventionjournals
We present a 13 - month old girl, who develop a post vaccination measles infection after a MMR vaccine , followed by a severe neutropenia. The hematological changes last more than one year and resolved spontaneously. We report the clinical case as an extremely rare and unknown side effect of the vaccine.
This document describes the case of a 22-year-old female patient who presented with fever, difficulty opening her mouth, ear discharge, oral ulcers, breathing difficulties, and cough after a recent tooth extraction. Testing showed sinusitis, oral candidiasis, low lymphocyte counts, and elevated inflammatory markers. A CT scan found lung lesions and the patient was diagnosed with Wegener's granulomatosis based on a positive C-ANCA and lung biopsy showing necrotizing vasculitis. Treatment with steroids and rituximab led to improvement of symptoms. Wegener's is a rare autoimmune disease characterized by necrotizing vasculitis affecting the respiratory tract and kidneys.
Ig A nephropathy (Cresentric) by Dr. Shami (SKIMS)Dr Shami Bhagat
This document provides a guide and presentation on a case of IgA nephropathy (Berger's disease). It summarizes the 23-year-old male patient's presentation with leg swelling and nausea, normal blood pressure and no diabetes. Renal biopsy showed focal endocapillary and mesangial proliferative crescentic IgA nephropathy. The patient was treated with hemodialysis, steroids, and cyclophosphamide and his creatinine improved after 3 months. The document then reviews pathogenesis, clinical presentations, diagnosis, pathologic findings including MEST-C scoring, and treatment of IgA nephropathy.
This document discusses the production of interferon through genetic engineering techniques. It begins by noting the scarcity of natural interferon and the potential for higher yields through recombinant DNA technology. It then explains the basic process of producing interferon genes in E. coli bacteria. While this approach promises greater quantities of interferon, issues around the differences between natural and recombinant interferon need further study. The document concludes by anticipating that recombinant interferon will soon be tested in clinical trials, which can help establish its value before widespread use.
common during attacks
Abdominal pain
affects up to 80%
may mimic appendicitis
often severe
affects up to 50%
aphthous ulcers in mouth and vagina
Fever
Skin rash
Oral/vaginal ulcers
Prof Ariyanto Harsono MD PhD SpA(K)
36
Diagnosis
Diagnosis is based on clinical findings and confirmed by
genetic testing.
During attacks, IgD levels are markedly elevated (10-100
The document discusses the history and early studies of transfer factors, which are immune system regulators found in colostrum that can transfer immunity. Early studies showed transfer factors from blood were effective against various infections and diseases but posed contamination risks. Researchers then found transfer factors in bovine colostrum that were non-species specific and more effective. Later studies showed bovine colostrum transfer factors reduced relapse in Burkitt's lymphoma, showed preliminary benefits for AIDS patients, and helped treat recurrent cystitis.
This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
Case #1.
Azathioprine에 의한 심한 골수부전 환자를 소개 하였습니다.
실제로 소개드린 첫번째 문헌(GUT)에 의하면 골수 억제의 부작용은 초기 치료 기간에 집중되어 있지만 전 치료 기간에 발생될 수 있는 것으로 되어 있습니다. 문헌들에 의하면 TPMT 활성이 저하된 환자에게 많이 발생하고 투여 전 TPMT 활성을 검사 한 후 치료를 시작 하여야 한다는 내용들이 많습니다. 그러나 TPMT 검사는 고가에 오랜 검사기간이 걸리는 검사입니다(비보험 225,750원, 20일). 또한 슬라이드에 소개드린 두번째 문헌(DDS)에는 스크리닝 검사의 효용성에 대하여 회의적인 결과를 보고 하였습니다.
면역 억제제 투여시 첫 약물로써 가장 간단하게 투여할 수 있는 이뮤란(Azathioprine)이라는 이름의 약물 역시도 주의하며 투여 해야 할 약물 이라 생각 됩니다. 심각한 혈액학적 합병증의 발생률은 약 6% 정도로 보고되고 있으며, 류마티스질환 치료 하시는 분들 역시도 오랜 치료기간 한두번의 경험을 할 수 있는 정도라고 합니다. 사용을 안할 수 없는 약물인 만큼 투여 전 환자와 보호자에게 발생 가능한 부작용에 대한 충분한 설명이 필요 하다고 생각 합니다.
Case #2.
Hepatic enz. elevation 주소로 오신 분이고, non-A, non-B hepatitis로써 ANA 검사상 high titer 소견을 보였습니다. 그런데 ANA 보고시 간과할 수 있는 ANA pattern이 'Discrete speckled' 로 보고되고 Anti Centromere Ab. 양성소견 이었습니다. 다시 병력 청취 하였더니 Raynaud disease가 의심 되었던 case 입니다. ANA 검사 결과를 볼때 titer 뿐 아니라 pattern도 챙겨 보아야 한다는 교훈을 얻었던 case 입니다.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
This paper continues the authors investigation into AD. We find that hydrogen peroxide appears to be the culprit in attacking the Papez circuit, especially in women. Familiarity with AT Math is assumed.
Mucocutaneous Involvement in Behcets Diseasenavasreni
Behçet’s disease is a chronic inflammatory disease characterized by its clinical polymorphism associating mucocutaneous involvement to systemic manifestations. The mucocutaneous lesions are considered the hallmark of the disease, being the most common symptoms presenting at the onset of disease. Our objective was to determine the characteristics of this skin involvement during Behçet’s disease. We conducted a descriptive study over a period of 30 years, having collected all patients with Behçet’s disease.
Eosinophilic Enterocolitis: A Rare Nosological Entitynavasreni
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
This paper provides some simple calculations from AT Math and Physics on how stuttering may occur. We see that adrenaline affects the frequency of the human mind resulting in a nerve signal velocity that is too slow for the tongue muscle to respond, thus no clear speech.
Ethics Review Preparedness During COVID-19 Outbreak and Local IRBs in Pakista...navasreni
Current COVID-19 outbreak has shaken almost all aspects of health. Pakistan is lower middle income
country where health system is fragmented due to chronic state of underinvestment in health. Provision
of basic health care during the current COVID-19 outbreak remains daunting task. Ethics and
regulatory systems are not fully mature [1]
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Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
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Clinical Case of Post-Vaccination Measles Followed By Severe Neutropeniainventionjournals
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common during attacks
Abdominal pain
affects up to 80%
may mimic appendicitis
often severe
affects up to 50%
aphthous ulcers in mouth and vagina
Fever
Skin rash
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Prof Ariyanto Harsono MD PhD SpA(K)
36
Diagnosis
Diagnosis is based on clinical findings and confirmed by
genetic testing.
During attacks, IgD levels are markedly elevated (10-100
The document discusses the history and early studies of transfer factors, which are immune system regulators found in colostrum that can transfer immunity. Early studies showed transfer factors from blood were effective against various infections and diseases but posed contamination risks. Researchers then found transfer factors in bovine colostrum that were non-species specific and more effective. Later studies showed bovine colostrum transfer factors reduced relapse in Burkitt's lymphoma, showed preliminary benefits for AIDS patients, and helped treat recurrent cystitis.
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Case #1.
Azathioprine에 의한 심한 골수부전 환자를 소개 하였습니다.
실제로 소개드린 첫번째 문헌(GUT)에 의하면 골수 억제의 부작용은 초기 치료 기간에 집중되어 있지만 전 치료 기간에 발생될 수 있는 것으로 되어 있습니다. 문헌들에 의하면 TPMT 활성이 저하된 환자에게 많이 발생하고 투여 전 TPMT 활성을 검사 한 후 치료를 시작 하여야 한다는 내용들이 많습니다. 그러나 TPMT 검사는 고가에 오랜 검사기간이 걸리는 검사입니다(비보험 225,750원, 20일). 또한 슬라이드에 소개드린 두번째 문헌(DDS)에는 스크리닝 검사의 효용성에 대하여 회의적인 결과를 보고 하였습니다.
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Case #2.
Hepatic enz. elevation 주소로 오신 분이고, non-A, non-B hepatitis로써 ANA 검사상 high titer 소견을 보였습니다. 그런데 ANA 보고시 간과할 수 있는 ANA pattern이 'Discrete speckled' 로 보고되고 Anti Centromere Ab. 양성소견 이었습니다. 다시 병력 청취 하였더니 Raynaud disease가 의심 되었던 case 입니다. ANA 검사 결과를 볼때 titer 뿐 아니라 pattern도 챙겨 보아야 한다는 교훈을 얻었던 case 입니다.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
Similar to A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C.Nt 1588,-69G> (17)
This paper continues the authors investigation into AD. We find that hydrogen peroxide appears to be the culprit in attacking the Papez circuit, especially in women. Familiarity with AT Math is assumed.
Mucocutaneous Involvement in Behcets Diseasenavasreni
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A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C.Nt 1588,-69G>
1. Annals of Clinical and Medical
Case Reports
ISSN 2639-8109
Case Report
A Mild form of Familial Mediterranean Fever Associated with a
Polymorphisms C.Nt 1588,-69G>
Arcoleo F1
, Fabiano C2
, Barone SL3
and Cillari E1,4,*
1
Clinical Pathology Unit . Villa Sofia-Cervello Hospital, Palermo
2
Molecular Genetics, Villa Sofia-Cervello Hospital, Palermo
3
Internal Medical Medicine Unit, Candela Clinic, Palermo
4
Palermo and Consultant Baiata Center, Via Capitano Sieli, Trapan
Volume 4 Issue 6- 2020
Received Date: 09 July 2020
Accepted Date: 20 July 2020
Published Date: 24 July 2020
*Corresponding Author (s): Enrico Cillari, Clinical Pathology Unit. Villa Sofia-Cer-
vello Hospital, Palermo, Consultant Clinical Pathology Unit. Villa Sofia-Cervello
Hospital, Palermo and Consultant Baiata Center, Via Capitano Sieli, Trapani,
E-mail: cillari52@hotmail.it
Citation: Cillari E. A Mild form of Familial Mediterranean Fever Associated with a Polymor-
phisms C.Nt 1588,-69G>. Annals of Clinical and Medical Case Reports. 2020; 4(6): 1-2.
2. Key words
Cutìaneous inflammation; Pyrin-
marenostrin; Polymorphism
1. Abstract
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused by
mutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized by
recurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation. Until now more
than 304 sequence variants have been recorded. Here, we describe a case of mild FMF confirmed
by analysis of the MEFV gene, characterized by polymorphism c1588-69G>A. The patient had a
good answer to the treatment with colchicine, that, unfortunately, he stopped for severe gastroin-
testinal side effects. The detection of polymorphism for intron 5 c1588-69G>A is not rare, since it
was also detected in healthy subjects, and the observation seem to suggest that this polymorphism
is associated with a symptomatic pour severe form and other factors can act as triggering factors of
symptoms.
3. Introduction
Familial Mediterranean Fever (FMF) is an autosomal recessive
autoinflammatory disease caused by mutation(s) in the Mediter-
ranean fever (MEFV, pyrinmarenostrin) gene [1, 2]. FMF is char-
acterized by recurrent fever crisis combined with serosal, synovial,
or cutaneous inflammation and, in some individuals, the eventual
development, in the long-term, of systemic AA amyloidosis [3, 4].
FMF mainly affects peoples living along eastern Mediterranean Sea
(Turks, Sephardic Jews, Armenians) and is not rare disease in oth-
er Mediterranean areas such as Greeks, Italians and Iranians [4,
6]. Until now more than 304 sequence variants have been record-
ed [6]. In Italy M694V, V726A, M680I, M694I and E148Q are the
most frequent FMF-associated mutations [7].
Here, we describe a case of mild FMF confirmed by analysis of the
MEFV gene, characterized by polymorphism c1588-69G>A.
4. Case report
An fifty four year old women (SD) was referred to our hospital due
to recurrent and unpredictable irregular febrile episodes, general-
ly lasting 24 h to 72h. She presented other associated symptoms:
mild erysipelas-like skin rash and arthritic attack. Family history
revealed that her father died because of leukemia, and mother of
cerebral infarction. Renal disease, periodic fever, autoimmune and
metabolic diseases or auto-inflammatory disease were excluded
in the family anamnesis. Laboratory features included a moder-
ate elevation of sedimentation rate (40mm/hr; normal: 0-29mm/
hr), of C-reactive protein (1,5 mg/dl; normal:<0,5), of fibrinogen
(550mg/dL: normal 150-400 mg/dL) with an increased number of
leucocytes (11.000/uL with 63% neutrophils, 32% lymphocytes, 4%
eosinophils, 1% monocytes). All the other parameters (proteins,
immunoglobulins, haptoglobulin, prothrombin and tromboplastin
time, serum immunofixation electrophoresis, k l-free light chains,
creatinine, microalbumin, transaminases, bilirubin, alkaline fosfa-
tase, anti-cyclic citrullinated peptide (CCP) antibody, antinuclear
antibody, myeloproxidase antineutrophil cytoplasmatic antibody
(MPO-ANCA) and proteinase -3 (PR3 ANCA) were in the nor-
mal range. The analysis of serum amyloid (SAA) was 2,98 mg/L
(normal values 6,4) and was always negative in the long run. The
abdominal ultranonography reveals a slight steatosis. Echocardi-
ography was normal.
The genetic analysis was carried out on genomic DNA isolated
from peripheral leukocytes by the salting-out method [8]. By PCR
and direct sequencing we analyzed MEFV gene, TNFRSF1A gene
(for periodic syndrome associated to TNF receptor, TRAPS) and