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Şen N, Acer Kasman S, Baysal T, Dizman R, Yılmaz-Öner S, Tezcan ME. Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort. Clin Rheumatol 2023; 42:1363-1370. [PMID: 36725780 PMCID: PMC9891658 DOI: 10.1007/s10067-023-06526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is one of the common autoinflammatory diseases with multisystemic manifestation. Pleuritis is the only known pulmonary involvement of FMF; however, as far as we know, thoracic involvements in pleural, parenchymal, bronchial, and vascular structures have not been evaluated yet. METHOD We included 243 consecutive FMF patients who applied to our clinic within the last 5 years and were requested to have a thorax CT for any reason and 122 trauma patients without any comorbidity. An experienced radiologist evaluated the thorax CT images blindly according to the relevant guidelines. We then presented the common incidental pulmonary and mediastinal findings on the thorax CT. Additionally, we compared patients with and without lung involvement according to demographic and disease-related parameters. RESULTS In our study, 167 of 243 patients (68.7%) had at least one of the pulmonary findings on their thorax CT. The most common pulmonary findings were apical fibrosis in 96 (39.5%) patients, parenchymal fibrotic changes in 48 (19.8%) patients, and a solitary parenchymal nodule smaller than 4 mm in 33 (13.6%) patients. All demographic, genetic, and disease-related characteristics, including the frequency of spondyloarthropathy, were similar in patients with and without pulmonary findings. CONCLUSIONS We showed that the most common incidental pulmonary finding in our FMF cohort was apical fibrosis on thoracic CT. Our data did not show causality between FMF and apical fibrosis; therefore, more studies are needed to evaluate the frequency and clinical significance of apical fibrosis in FMF. Key Points • More than two-thirds of familial Mediterranean fever (FMF) patients in our study group who underwent a thoracic scan for any reason had pulmonary and mediastinal findings on thorax computed tomography (CT). • In our FMF cohort, the most common incidental pulmonary finding on their thorax CT was apical fibrosis. • All demographic and disease-related characteristics, including the frequency of spondyloarthritis, were similar between patients with and without pulmonary and mediastinal findings.
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Affiliation(s)
- Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Sevtap Acer Kasman
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey.
| | - Tamer Baysal
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Rıdvan Dizman
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Sibel Yılmaz-Öner
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Mehmet Engin Tezcan
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
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Nishiyama M, Takahashi K, Morizumi S, Takahashi Y, Iwamura S, Sumitomo K, Nakano S, Shinohara T. Transient and Recurrent Pulmonary Infiltrations Associated with Familial Mediterranean Fever. Intern Med 2022; 61:3415-3419. [PMID: 36385047 PMCID: PMC9751738 DOI: 10.2169/internalmedicine.8951-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chest symptoms and pleural effusion due to serositis in familial Mediterranean fever (FMF) are occasionally misdiagnosed as acute pneumonia. However, the actual pulmonary involvement of FMF is extremely rare. A 67-year-old man was referred to our hospital due to repeated and transient anterior chest pain. Chest images revealed a moderate amount of pericardial fluid, slight bilateral pleural effusion, and infiltrations in both lower lung lobes. Colchicine treatment without antibiotics rapidly improved these symptoms and findings. Pericarditis, pleurisy and the response to colchicine indicated FMF. FMF should be considered as a causative disease of pulmonary infiltrations, especially if it occurs repeatedly.
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Affiliation(s)
- Miho Nishiyama
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
| | - Kiyohide Takahashi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
| | - Shun Morizumi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Yoshinobu Takahashi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
| | | | - Kenya Sumitomo
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
| | - Seiichi Nakano
- Division of Otolaryngology, National Hospital Organization Kochi Hospital, Japan
| | - Tsutomu Shinohara
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Japan
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3
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Tsur AM, Watad A, Gendelman O, Nissan D, Cohen AD, Amital H. Familial Mediterranean Fever and Asthma. Rheumatology (Oxford) 2021; 60:5642-5646. [PMID: 33590869 DOI: 10.1093/rheumatology/keab159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the association between familial Mediterranean fever and asthma. METHODS This study was designed as a cross-sectional study. All patients diagnosed with familial Mediterranean fever between January 1, 2000, to December 31, 2016, who were prescribed colchicine were included in the study. Controls were matched by sex, date of birth, residential socioeconomic status, and country of birth. Logistic regression models were used to determine the odds ratio for asthma in familial Mediterranean fever patients and controls. RESULTS A total of 7,098 familial Mediterranean fever patients who were prescribed colchicine were identified. Of them, 3,547 (50%) were females, 3,632 (51%) were of low residential socioeconomic status and 6,160 (87%) were born in Israel. Their median age at the end of follow-up was 37 years (23-54). In an unadjusted logistic regression, familial Mediterranean fever was associated with asthma (OR = 1.33, 95%CI 1.17-1.51; p < 0.001). The association persisted after adjusting for sex, socioeconomic status, and country of birth (OR = 1.33, 95%CI 1.18-1.52; p < 0.001). CONCLUSIONS Familial Mediterranean fever is positively associated with asthma. Further research is required to validate our results and explore possible explanations of this association. These findings cast doubt on previous studies implying familial Mediterranean fever to be a protective factor from asthma.
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Affiliation(s)
- Avishai M Tsur
- Department of Medicine 'B'. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Abdulla Watad
- Department of Medicine 'B'. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Gendelman
- Department of Medicine 'B'. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Nissan
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B'. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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4
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Tufan A, Lachmann HJ. Familial Mediterranean fever, from pathogenesis to treatment: a contemporary review. Turk J Med Sci 2020; 50:1591-1610. [PMID: 32806879 PMCID: PMC7672358 DOI: 10.3906/sag-2008-11] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022] Open
Abstract
Familial Mediterranean fever (FMF) (OMIM #249100) is the most common hereditary autoinflammatory disease in the world. FMF is caused by gain of function mutations of MEFV gene which encodes an immune regulatory protein, pyrin. Over the last few years, we have witnessed several new developments in the pathogenesis, genetic testing, diagnosis, comorbidities, disease related damage and treatment approaches to FMF. Elucidation of some of the pathogenic mechanisms has led to the discovery of pathways involved in inflammatory, metabolic, cardiovascular and degenerative diseases. The use of next generation sequencing in FMF has revealed many new gene variants whose clinical significance may be clarified by developing functional assays and biomarkers. Clinically, although FMF is considered an episodic disease characterized by brief attacks, recent systematic studies have defined several associated chronic inflammatory conditions. Colchicine is the mainstay of FMF treatment, and interleukin (IL)-1 antagonists are the treatment of choice in refractory or intolerant cases. Experience of IL-1 antagonists, anakinra and canakinumab, is now available in thousands of colchicine resistant or intolerant FMF patients. In this contemporary review, we surveyed current FMF knowledge in the light of these recent advances.
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Affiliation(s)
- Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University, Ankara, Turkey
| | - Helen J Lachmann
- National Amyloidosis Centre, Royal Free London NHS Foundation Trust and University College London, London, UK
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Ishizuka K, Shikino K, Ikusaka M. Recurrent pleuritis with pleural thickening as the manifestation of familial Mediterranean fever. J Gen Fam Med 2020; 21:197-198. [PMID: 33014674 PMCID: PMC7521786 DOI: 10.1002/jgf2.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kosuke Ishizuka
- Department of General Medicine Chiba University Hospital Chiba Japan
| | - Kiyoshi Shikino
- Department of General Medicine Chiba University Hospital Chiba Japan
| | - Masatomi Ikusaka
- Department of General Medicine Chiba University Hospital Chiba Japan
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6
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Talerico R, Cardillo C, De Vito F, Schinzari F, Soldato M, Giustiniani MC, Verrecchia E, Manna R. Mesothelioma in Familial Mediterranean Fever With Colchicine Intolerance: A Case Report and Literature Review. Front Immunol 2020; 11:889. [PMID: 32477360 PMCID: PMC7237567 DOI: 10.3389/fimmu.2020.00889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/17/2020] [Indexed: 12/01/2022] Open
Abstract
A 65-year-old Italian physician affected by Familial Mediterranean fever (FMF) was hospitalized due to progressive abdominal enlargement, which had begun 6 months before admission. Physical examination revealed ascites and bilateral leg edema. Abdominal CT scan showed ascitic fluid and extensive multiple peritoneal implants; peritoneal CT-guided biopsy revealed an epithelial-type malignant mesothelioma. The patient's past medical history revealed recurrent episodes of abdominal pain and fever from the age of 2. Clinical diagnosis of FMF was suspected at the age of 25, while genetic analysis, performed at the age of 50, confirmed homozygosity for the M694I mutation in the MEFV gene. Treatment with the first line FMF drug colchicine was started and stopped several times because of worsened leukopenia. The patient in fact had a history of asymptomatic leukopenia/lymphopenia from an early age; the intake of colchicine aggravated his pre-existing problem until the definitive suspension of the drug. As for second-line drugs, canakinumab was first prescribed, but due to prescription issues, it was not possible to be administered. When he was given anakinra, there was a worsening of leukopenia leading to septic fever. Systematic literature review indicates that, in most cases, recurrent peritoneal inflammation results in benign peritoneal fibrosis or less commonly in encapsulating peritonitis. There are only a few reported cases of recurrent peritoneal inflammation progressing from FMF to peritoneal mesothelioma (MST). In such cases, intolerance to colchicine or its erratic intake may lead to long-term recurrent inflammation, which usually precedes the development of the tumor, while pre-existing leukopenia, as in our patient, could also be a factor promoting or accelerating the tumor progression. In conclusion, we suggest that in the presence of intolerance or resistance to colchicine, interleukin (IL)-1 inhibition could suppress peritoneal inflammation and prevent MSTs.
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Affiliation(s)
- Rosa Talerico
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Cardillo
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco De Vito
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Schinzari
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuel Soldato
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Giustiniani
- Department of Pathology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Verrecchia
- Department of Internal Medicine, Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Bouomrani S, Ghribi I, Regaïeg F, Belgacem N, Trabelsi S, Lassoued N, Baïli H, Béji M. Le mésothéliome péritonéal malin au cours de la fièvre méditerranéenne familiale. ONCOLOGIE 2017. [DOI: 10.1007/s10269-017-2739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Tarantino G, Esposito S, Andreozzi L, Bracci B, D'Errico F, Rigante D. Lung Involvement in Children with Hereditary Autoinflammatory Disorders. Int J Mol Sci 2016; 17:ijms17122111. [PMID: 27983684 PMCID: PMC5187911 DOI: 10.3390/ijms17122111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023] Open
Abstract
Short-lived systemic inflammatory reactions arising from disrupted rules in the innate immune system are the operating platforms of hereditary autoinflammatory disorders (HAIDs). Multiple organs may be involved and aseptic inflammation leading to disease-specific phenotypes defines most HAIDs. Lungs are infrequently involved in children with HAIDs: the most common pulmonary manifestation is pleuritis in familial Mediterranean fever (FMF) and tumor necrosis factor receptor-associated periodic syndrome (TRAPS), respectively caused by mutations in the MEFV and TNFRSF1A genes, while interstitial lung disease can be observed in STING-associated vasculopathy with onset in infancy (SAVI), caused by mutations in the TMEM173 gene. The specific pleuropulmonary diseases may range from sub-clinical abnormalities during inflammatory flares of FMF and TRAPS to a severe life-threatening disorder in children with SAVI.
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Affiliation(s)
- Giusyda Tarantino
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Laura Andreozzi
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
| | - Benedetta Bracci
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
| | - Francesca D'Errico
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
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La Regina M, Orlandini F, Manna R. Autoinflammatory diseases: a possible cause of thrombosis? Thromb J 2015; 13:19. [PMID: 25969671 PMCID: PMC4428094 DOI: 10.1186/s12959-015-0049-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Autoinflammatory diseases are a group of disorders due to acquired or hereditary disfunction of innate immune system and characterized by systemic or localized manifestations. The prototype is Familial Mediterranean Fever, a monogenic hereditary disorder, whose causing gene (MeFV gene) was identified in 1997 and opened the way to a new fascinanting chapter of rheumatology. A growing body of monogenic and poligenic autoinflammatory disorders has been described since then. Arterial and venous thrombosis is a common medical problem, with significant morbidity and mortality. Strong evidences from basic research and clinical epidemiological studies support the theory that inflammation and thrombosis can be associated. Because of their recurrent/chronic inflammatory nature, autoinflammatory diseases are a putative cause of thrombotic manifestations. In the present work, we reviewed the available evidences about monogenic autoinflammatory disorders, complicated by thrombotic manifestations.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Ligurian East Hospital, La Spezia, Italy
| | | | - Raffaele Manna
- Centre of Periodic Fevers - Catholic University of Rome, Rome, Italy
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10
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[Mesothelioma and familial Mediterranean fever: A relationship?]. Rev Mal Respir 2014; 32:271-4. [PMID: 25847205 DOI: 10.1016/j.rmr.2014.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 06/14/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The majority of pleural and peritoneal mesotheliomas are linked to asbestos exposure but, in around 20% of cases, no history of such exposure is found. Periodic disease is associated with recurrent serositis, which could favor the development of mesothelioma. CASE REPORT We report a case of pleural mesothelioma in a 50-year-old Lebanese woman, with no detectable exposure to asbestos but suffering from periodic disease (familial Mediterranean fever) with recurrent episodes of serositis. DISCUSSION Many cases of peritoneal mesothelioma in patients with FMF are reported in the literature. This is the second reported case of pleural mesothelioma associated with periodic disease. Because of the low incidence of both diseases, further publications are required to support the hypothesis of a causal link. It is important, therefore, that all cases of an association of periodic disease and mesothelioma are reported.
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Sargsyan AV, Narimanyan MZ. P01-047 – PH with right-sided heart failure in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952514 DOI: 10.1186/1546-0096-11-s1-a50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Kushima H, Ishii H, Ishii K, Kadota JI. Pulmonary Necrotizing Granulomas in a patient with familial mediterranean fever. Mod Rheumatol 2013; 25:806-9. [DOI: 10.3109/14397595.2013.844398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Inoue K, Torii K, Yoda A, Kadota K, Nakamichi S, Obata Y, Nishino T, Migita K, Kawakami A, Ozono Y. Familial Mediterranean fever with onset at 66 years of age. Intern Med 2012; 51:2649-53. [PMID: 22989844 DOI: 10.2169/internalmedicine.51.6846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 68-year-old woman who had experienced recurrent febrile episodes since 66 years of age. Despite various examinations and treatments, the etiology remained unclear. Further examinations following another referral failed to uncover the cause. Therefore, despite her age, it was presumed that she had familial Mediterranean fever. An analysis of the familial Mediterranean fever (MEFV) gene detected heterozygous L110P, E148Q, and R202Q mutations. No further febrile episodes occurred after colchicine treatment was initiated. Familial Mediterranean fever presenting in patients in their sixties is extremely rare.
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Affiliation(s)
- Keita Inoue
- Department of General Medicine, Nagasaki University School of Medicine, Japan.
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14
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Nussinovitch U, Livneh A, Kaminer K, Langevitz P, Feld O, Nussinovitch M, Volovitz B, Lidar M, Nussinovitch N. Normal autonomic nervous system responses in uncomplicated familial Mediterranean fever: a comparative case-control study. Clin Rheumatol 2011; 30:1347-51. [PMID: 21541656 DOI: 10.1007/s10067-011-1759-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 04/17/2011] [Indexed: 02/07/2023]
Abstract
There is a paucity of knowledge regarding the autonomic nervous system function in patients with familial Mediterranean fever (FMF). Therefore, our aim was to evaluate autonomic responses in patients with FMF using complementary tests. The study groups included 33 patients with uncomplicated FMF and 39 control subjects. Autonomic function was evaluated by measuring responses to metronomic breathing, the Valsalva maneuver, and the Ewing maneuver. Autonomic parameters were computed from electrocardiograms with designated computer software. There were no statistically significant differences in any of the measured parameters of autonomic function between the patient and control group. The measured autonomic parameters of both groups were similar to those previously reported in healthy individuals. In conclusion, patients with FMF who did not develop amyloidosis due to continuous colchicine treatment appeared to have normal autonomic function, as reflected by the normal response to physiological autonomic stimuli.
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Affiliation(s)
- Udi Nussinovitch
- The Heller Institute of Medical Research, and Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel, 52621.
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Abstract
Mesothelioma is a "new" malignant disease strongly associated with exposure to amphibole asbestos exposure (amosite and crocidolite) environmentally and in the work place. Nonetheless, in recent years, we have learned that many cases of mesothelioma are idiopathic, while some are caused by therapeutic irradiation or chronic inflammation in body cavities. This paper reviews the key epidemiological features of the malignancy in the context of the biological and mineralogical factors that influence mesothelioma development. These tumors challenge the diagnostic pathologist's acumen, the epidemiologist's skill in devising meaningful and definitive studies, the industrial hygienist's knowledge of environmental hazards in diverse occupational settings, and the clinician's skill in managing an intrepid and uniformly fatal malignancy.
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Affiliation(s)
- J E Craighead
- Department of Pathology, University of Vermont, Burlington, VT 05405, USA.
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16
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Wirtz G, Andrès E, Kessler R. [Thoracic impairment from familial Mediterranean fever: review of the literature and a case study]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:313-317. [PMID: 19878808 DOI: 10.1016/j.pneumo.2009.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 05/23/2009] [Indexed: 05/28/2023]
Abstract
Familial Mediterranean fever (FMF) is a recessive autosomal disease, predominantly affecting the population around the Mediterranean. The main clinical signs consist of attacks of fever associated with abdominal, articular and thoracic pain. Based on a case report, the authors describe the main thoracic forms of this illness comprising pleural pain, pleural effusion and pulmonary amyloidosis. The authors also discuss the association of mesothelioma and FMF. Colchicine is successfully used in the treatment of FMF.
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Affiliation(s)
- G Wirtz
- Service de Pneumologie, CHU de Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France.
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17
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Sengul E, Yildiz K, Topcu Y, Yilmaz A. Malignant Peritoneal Mesothelioma in a Hemodialysis Patient with Familial Mediterranean Fever: A Case Report and Literature Review. Scott Med J 2008. [DOI: 10.1258/rsmsmj.53.4.10j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Malignant mesothelioma is a rare tumor. The most common localization of mesothelioma is pleura. It rarely arises from the peritoneum. It has been suggested that familial Mediterranean fever (FMF) may cause the development of peritoneal mesothelioma. We describe a case of malignant peritoneal mesothelioma in a hemodialysis patient with FMF. The patient was a 56 year old female. A history of FMF was present since her childhood. She did not use colchicine and suffered from recurrent ascites. To the best of our knowledge, this is the seventh case of FMF diagnosed as having malignant peritoneal mesothelioma in the medical literature.
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Affiliation(s)
- E Sengul
- Department of Internal Medicine, Division of Nephrology Faculty of Medicine, University of Kocaeli, 41380, Kocaeli, Turkey
| | - K Yildiz
- Department of Pathology Faculty of Medicine, University of Kocaeli, 41380, Kocaeli, Turkey
| | - Y Topcu
- Department of Internal Medicine Faculty of Medicine, University of Kocaeli, 41380, Kocaeli, Turkey
| | - A Yilmaz
- Department of Internal Medicine, Division of Nephrology Faculty of Medicine, University of Kocaeli, 41380, Kocaeli, Turkey
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18
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Katsenos S, Mermigkis C, Psathakis K, Tsintiris K, Polychronopoulos V, Panagou P, Ritis K, Light RW. Unilateral lymphocytic pleuritis as a manifestation of familial Mediterranean fever. Chest 2008; 133:999-1001. [PMID: 18398120 DOI: 10.1378/chest.07-1736] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Familial Mediterranean fever (FMF) is an autosomal recessive disease affecting predominantly populations surrounding the Mediterranean basin. It is the most prevalent hereditary periodic fever syndrome characterized mainly by recurrent and short attacks of fever and serositis (pleuritis, arthritis, peritonitis). Unilateral polymorphonuclear exudative pleuritis associated with fever has been reported as the solitary manifestation of the first FMF attack, in < 10% of patients. This case study describes a 30-year-old Greek man with recurrent episodes of lymphocytic exudative pleuritis associated with fever. After a thorough workup (clinical criteria and molecular genetic testing identifying homozygosity polymorphisms of the FMF gene), the diagnosis of FMF was established. Treatment with colchicine, 2 mg/d, eliminated FMF attacks. To our knowledge, this is the first well-documented case report of a patient with FMF presenting with a lymphocytic exudative pleural effusion.
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Affiliation(s)
- Stamatis Katsenos
- Department of Pneumonology, Army General Hospital of Athens, Athens, Greece.
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Ascoli V, Cavone D, Merler E, Barbieri PG, Romeo L, Nardi F, Musti M. Mesothelioma in blood related subjects: report of 11 clusters among 1954 Italy cases and review of the literature. Am J Ind Med 2007; 50:357-69. [PMID: 17407142 DOI: 10.1002/ajim.20451] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Malignant mesothelioma is a sporadic tumor related to asbestos. Its occurrence in blood relatives raises the question of potential contribution of predisposing factors. METHODS The study analyses the features of mesothelioma in blood relatives that might explain the disease clustering. Data sources of familial clusters were three population-based Mesothelioma Registries in Italy (Veneto and Apulia Regions, Brescia province; 1978-2005) and Medline, Toxline, and Oshline/Hseline databases for a review of the literature (1968-2006). RESULTS Eleven clusters (22 cases) were identified among 1954 Italy mesothelioma cases, and 51 clusters (120 cases) were extracted from 33 studies. The proportion of Italy familial cases was 1.4 per 100 mesothelioma cases; the ratio between the number of familial clusters and the number of non-familial mesothelioma cases was 1:148. The mesothelioma profile in consanguineous is the same as in non-consanguineous subjects (male prevalence; pleural site; age at diagnosis >50 years; asbestos exposure). Most clusters occurred in asbestos workers (shipyard, asbestos-cement production/processing, and insulation) and household-exposed blood relatives. Others were related to asbestos-cement factory pollution, asbestos-in-place, and handling asbestos-contaminated textiles. Two clusters were without any known exposure. Cancer family history revealed lung cancer cases in eight clusters. CONCLUSIONS Available data support asbestos exposure as the main risk factor in mesothelioma cases among blood relatives. Our finding of a low proportion of familial cases would not suggest the influence of a large genetic component for mesothelioma in blood relatives.
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Affiliation(s)
- Valeria Ascoli
- Department of Experimental Medicine, University La Sapienza, Rome, Italy.
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Ishak GE, Khoury NJ, Birjawi GA, El-Zein YR, Naffaa LN, Haddad MC. Imaging findings of familial Mediterranean fever. Clin Imaging 2006; 30:153-9. [PMID: 16632148 DOI: 10.1016/j.clinimag.2005.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 05/25/2005] [Accepted: 06/10/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to study the imaging findings of familial Mediterranean fever (FMF). MATERIALS AND METHODS We performed a retrospective review of the medical records and imaging studies of 38 patients with proven FMF, diagnosed between 1992 and 2002. RESULTS The most common clinical manifestation was recurrent peritoneal attacks with abdominal pain (76.3%) and fever (42.1%). Abdominal imaging findings included ileus (n=12), splenomegaly (n=5), hepatomegaly (n=2), ascitis (n=2), focal peritonitis (n=2), mesenteric streaking (n=1), and enlarged mesenteric lymph node (n=1). One patient developed fatal peritoneal mesothelioma, and 13.1% of the patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency, occurring in 34.2% of patients; radiographs were normal (n=4) or showed joint effusion and periarticular soft tissue swelling (n=4) due to synovitis. One patient developed seronegative destructive arthropathy. Skin lesions were noted in 23.6% of patients. Pleuritis was encountered in 13.1% and pericarditis in 5.2%. Polyarteritis nodosa (PAN) was present in two patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. CONCLUSION FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings, and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. PAN, multiple sclerosis, and autoimmune hemolytic anemia are probably rare associations or rather than coincident with FMF.
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Affiliation(s)
- Gisele E Ishak
- Department of Diagnostic Radiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
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Erdem H, Simşek I, Pay S, Dinc A, Deniz O, Ozcan A. Diffuse Pulmonary Amyloidosis That Mimics Interstitial Lung Disease in a Patient With Familial Mediterranean Fever. J Clin Rheumatol 2006; 12:34-6. [PMID: 16484879 DOI: 10.1097/01.rhu.0000200424.58122.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Familial Mediterranean fever (FMF) is an autosomal-recessive disorder characterized by recurrent attacks of fever, serositis, and arthritis. Amyloidosis, which mostly affects the kidneys, represents the most serious complication of the disease. The lungs, particularly after the onset of renal failure, may be asymptomatically involved in some of the patients with AA amyloidosis secondary to FMF. However, clinically detectable pulmonary amyloidosis is quite rare, and only 2 cases of pulmonary amyloidosis secondary to FMF have been reported so far. We describe a patient with pulmonary amyloidosis who had pulmonary hypertension and presented with clinical and radiologic features highly suggestive of interstitial lung disease. Amyloidosis was diagnosed only after lung biopsy. FMF was confirmed by molecular analysis.
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Affiliation(s)
- Hakan Erdem
- Department of Medicine, Division of Rheumatology, Gülhane Military School of Medicine, Etlik/Ankara, 06018, Turkey.
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