A Very Rare Cause of Pleuritic Chest Pain: Bilateral Pleuritis as a First Sign of Familial Mediterranean Fever

The familial Mediterranean fever (FMF), also called recurrent polyserositis, is characterized by reccurrent episodes of serositis at pleura, peritoneum, and synovial membrane and fever. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. A 59-year-old Turkish man suffered from recurrent pleuritic chest pain due to pleural effusion and atelectasis. The etiology was not found, and his symptoms were spontaneously recovered during several weeks. The pleuritic chest pain was associated with abdominal pain in the last attack. The gene mutation analysis revealed the homozygosity of FMF (F479L) gene mutation in both our patient and his grandchild. After the colchicine treatment, the attack has not developed. In conclusion, recurrent pleural effusion and pleuritic chest pain may be the first signs of the FMF. 1. Introduction The familial Mediterranean fever (FMF), an autosomal recessive condition, affects more than one hundred thousand people worldwide and, as such, is the most common of the hereditary periodic fevers [1]. The FMF has affected mainly Mediterranean populations including non-Ashkenazi Jews, Arabs, Turks, and Armenians. It is characterized chiefly by short and periodic attacks of fever and serositis involving the pleura, peritoneum, synovial membrane, and tunica vaginalis [2]. Pulmonary involvements of FMF because of inflammation of pleura were reported by 30–40% of patients. They are usually present with unilateral pleuritis and fever [3, 4]. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. 2. Case Presentation A 59-year-old Turkish man was admitted to the hospital with pleuritic chest pain on right hemithorax, dyspnea, cough, and fever (38.5°C). Physical examination showed the decreased breath sound and pleural frotman with auscultation. The chest radiography also showed pleural effusion with linear atelectasis on right side lung (Figure 1). Figure 1: Chest radiography showing pleural effusion with linear atelectasis on the right lung. Thorax CT was performed and this showed more right sided bilateral pleural effusion and linear atelectasis (Figure 2). Figure 2: Thorax computed tomography showing the bilateral pleural effusion and linear atelectasis. Laboratory findings demonstrated the leukocytosis (favor to polymorphonuclear cell) and increased erythrocyte sedimentation rate (69？mm/h). The patient was treated with antibiotic (cefuroxime and clarithromycin) for pneumonia and pleuritis but did not improve. The lung