A 33-year-old moderately mentally handicapped man who was living in a group home presented to our clinic with a 1-week history of pain, swelling, and erythema of the lower portion of the right leg and foot. The patient was of Roman Catholic, Italian origin, although the history of his distant family revealed that some of his relatives had emigrated from North Africa. The patient's symptoms had been ongoing for 5 years, recurring approximately every 2 to 3 months, with no known triggering factors. With each recurrence, marked edema and erythema of the lower portion of the right leg was noted with severe pain and tenderness. Questioning of the patient's caregiver revealed that with the swelling and discomfort, the patient developed a flulike illness consisting of fever, diaphoresis, abdominal pain, and frequent vomiting. Aggressive and irritable behavior for 2 to 3 days preceded the onset of the acute episodes. Specific respiratory and neurologic signs or symptoms were not noted, but the patient complained of right hip and right knee pain, which could not be explained with objective findings. The acute phase, which always began suddenly, lasted approximately 7 to 10 days and resolved within another 2 weeks with mild residual edema of the right foot. There was no evidence of trauma. The patient was taking several long-term, continuous psychotropic medications to control his behavior. He had no known allergies or other medical conditions. No other family member, including the patient's only sibling, has shown any signs of a similar disorder.
Muhn CY, Rosenthal D, Browne C, Jakubovic H, Fisher BJ. Familial Mediterranean Fever. Arch Dermatol. 1998;134(8):929–931. doi:10.1001/archderm.134.8.929
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