The Suffering Little "Princess": A Familial Mediterranean Fever Case

A three-and-a-half-year-old girl was brought by her parents with a long history of suffering that began when she was only 6 months old. She had recurrent attacks of fever and "colic" that became more frequent over time, eventually presenting as episodes of high fever, very severe abdominal pain and knee pain — occurring almost every week.

The parents were heartbroken every time an attack came, and helpless to ease her pain. Many investigations had been done without a diagnosis; several medications had been tried without benefit. They were exhausted by a mysterious disease that had caused so much suffering in such a young child.

The clinical suspicion

We suspected a relatively rare condition called Familial Mediterranean Fever (FMF) — an inherited autoinflammatory disorder characterised by recurrent episodes of fever and serosal inflammation (typically affecting the abdomen, chest and joints). We sent for genetic testing and started empirical treatment with low-dose colchicine.

The next attack came a week later and was still severe, so we increased to a moderate dose. The parents were initially concerned about side effects and objected, but we explained that colchicine is a relatively safe medicine when properly monitored, and they agreed.

The turning point

One week later the father called — ecstatic. She had another attack, but it was the mildest she had ever had: only mild fever and mild knee pain, and no abdominal pain at all. For the first time in three years, the family saw hope.

The lab results came back shortly after and confirmed the diagnosis, showing that she carried a rare genetic profile for FMF — likely a result of her father being Arab and her mother Eastern European. This particular profile is known to cause more severe disease than usual. Case solved. Suffering stopped.

Why this case matters

FMF is uncommon but not rare in the Middle East and Mediterranean populations. Early recognition matters for two reasons:

• Symptom control: Colchicine is highly effective when started early and prevents the crippling recurrent attacks.
• Preventing amyloidosis: Untreated FMF can lead to secondary amyloidosis and kidney failure over years.

If your child has recurrent unexplained fevers with abdominal or joint pain, and no infection has been found, ask for a paediatric rheumatology assessment. A specific diagnosis can transform a family's life.

It is always gratifying to ease the pain and suffering of patients — but especially so when we can end years of suffering in a child.

Paediatric rheumatology at Health Call Clinic

Dr Bassel Darwish is a Consultant Rheumatologist with specialist expertise in paediatric rheumatology and autoinflammatory diseases, including FMF and juvenile idiopathic arthritis. Consultations are available at Dubai Healthcare City.