Some things are still a Clinical Diagnosis

I saw a man of 28 as a new patient this week, born in France.

I saw a man of 28 as a new patient this week, born in France. Episodic severe right upper quadrant pain. The more I listened to him, the more it was clear that it was very episodic (3-4 per year) and very severe. On one occasion he had been to A&E. The doctors had been concerned about a blood test suggesting inflammation somewhere and wanted to do an operation, but he felt it was not needed. I asked him if his parents were French, and he said one was from Morocco. Therefore, the diagnosis is probably……….Familial Mediterranean Fever. This is an inherited disorder that occurs in some people of Mediterranean origin, who are subject to these episodic attacks of abdominal pain due to peritoneal inflammation, severe enough to occasionally have lapaorotomies which turn out to be normal apart from some serous fluid in the peritoneal cavity. They can also be subject to pleuritic pain and joint pain. Tests are essentially normal between attacks, while inflammatory markers are significantly raised during episodes of pain. Attacks can be prevented by using Colchicine, and controlling the inflammatory process is important, as there is a risk of developing Amyloid.

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