Presentación atípica de un caso de fiebre mediterránea familiar / Atypical presentation of a case of familial mediterranean fever

La fiebre mediterránea familiar (FMF) es un síndrome hereditario de fiebre periódica caracterizada por ataques cortos de fiebre e inflamación multisistémica (poliserositis y sinovitis, principalmente). El desarrollo de amiloidosis, sobre todo renal, es la principal complicación. Los síntomas aparecen, en la mayoría de casos, antes de la segunda década de vida. Se trata de una enfermedad hereditaria monogénica y el gen asociado se llama MEFV. El diagnóstico genético puede ser de gran ayuda, aunque existen aspectos que todavía no están claros. En un porcentaje muy pequeño de pacientes, la enfermedad aparece de una forma atípica, es decir, más tardía e iniciando con amiloidosis, sin existir antecedente de ataques previos inflamatorios o fiebres periódicas. Es el fenotipo II de la FMF. Presentamos el caso de un varón de 24 años con amiloidosis renal que cumple estas características, donde el estudio genético resultó clave para el diagnóstico (AU)

Familial Mediterranean Fever is a periodic hereditary fever syndrome characterised by short fever attacks and multisystemic inflammation (mainly polyserositis and synovitis). The main complication is development of amyloidosis, particularly renal. In the majority of cases, symptoms appear before the age of twenty. It is a monogenic hereditary disease that is related to the MEFV gene. A genetic diagnosis may be helpful, although there are some aspects that are still not clear enough. A small percentage of patients present an atypical form, appearing later and debuting with amyloidosis but without any previous inflammatory attacks or periodic fevers. This form is Familial Mediterranean Fever phenotype II. We present the case of a 24 year-old with renal amyloidosis that presents these characteristics and in whom the genetic study was fundamental for the diagnosis (AU)

[Pseudo-periodic disease with hyperimmunoglobulinemia D: a never-ending story with probable prenatal onset]. / Pseudomaladie périodique avec hyperimmunoglobulinémie D: une histoire sans fin de début anténatal probable.

UNLABELLED: Diagnosis of inflammatory non-infectious diseases with a neonatal onset is often retrospective. It may lead to aggressive and iatrogenic procedures. PATIENT: A 6-year-old boy was suffering, since birth, from recurrent febrile attacks including rashes, gastrointestinal manifestations and inflammatory joint involvement. This syndrome, partially improved with steroids, could have been of antenatal onset. Since the age of 4 years, the patient is considered as having hyper-IgD syndrome (HIDS). DISCUSSION: HIDS must be distinguished from familial Mediterranean fever. Patients suffer from recurrent fever concomitant to inflammatory joint involvement, abdominal distress, skin lesions, swollen lymph nodes and hepatosplenomegaly (especially seen in children). All patients have high serum IgD (> 100 UI/mL) and IgA levels. Nevertheless, a high IgD level is not specific. Our case could also be part of the CINCA (chronic, infantile, neurological, cutaneous and articular) syndrome, which includes similar early manifestations associated with a constant neurological and frequent ophthalmological involvement and epiphyseal changes; to date, these last three manifestations are not present in our patient. CONCLUSION: HIDS and CINCA syndrome are not known to be modified by any effective therapeutic agent. When presenting at birth, these inflammatory diseases must be considered as entities with a rarely described potential severity.

[Blood lipids in renal amyloidosis]. / Lipidy krovi pri amiloidoze pochek.

Serum lipids were estimated in patients with renal amyloidosis (RA): 21 with familial Mediterranean fever (FMF) and 24 with secondary renal amyloidosis versus FMF patients without renal dysfunction or having chronic glomerular nephritis. All the RA patients had dyslipidemia of atherogenic nature the severity of which correlated with that of renal disorder. Our results showed the presence of dyslipidemia early during RA course. It is renal involvement that results in dyslipidemia observed in FMF patients.