Work

A Case Report of Familial Mediterranean Fever Diagnosed following the Total Knee Arthroplasty

Year: 2015

Type: article

Abstract: Postoperative fever following orthopedic surgical procedures is common, but the cause of fever and its relation to infections is often unclear. Periprosthetic joint infection is a devastating complication following the total joint arthroplasty [8]. In the USA, periprosthetic joint infection is currently the most common indication for revision total knee arthroplasty and the third most common indication for revision total hip arthroplasty [2, 8]. Since no highly accurate diagnostic method exists, the diagnosis of infection is based on a combination of clinical suspicion, serological tests, culture results, histology, and basic molecular techniques. We present the case of a 62-year-old female who presented to our clinic with a fever of unknown origin following a total knee replacement. She was suspected to have a periprosthetic joint infection. Because of her recurrent febrile episodes associated with peritonitis, pleuritis, and synovitis, familial mediterranean fever (FMF) was suspected based on the Tel-Hashomer criteria, if two major or one major + two minor criteria are met (Major criteria are (1) recurrent febrile episodes associated with peritonitis, pleuritis, or synovitis; (2) amyloidosis of AA-type without a predisposing disease; and (3) favorable response to daily colchicine. Minor criteria are (1) recurrent febrile episodes, (2) erysipelas-like erythema, and (3) positive history of familial mediterranean fever in a first degree relative) [5]. As part of the workup for her fever, a genomic search for the mediterranean fever gene (MEFV) was performed, and heterozygous L110P, E148Q, and M694I mutations were found in the patient. FMF was confirmed by the mutation in the hot spot of MEFV. The patient’s symptoms were successfully controlled by administration of colchicine.

Source: HSS Journal® The Musculoskeletal Journal of Hospital for Special Surgery

DOI: 10.1007/s11420-015-9444-x

Authors: Sumito Kawamura, Kazunaga Agematsu, Daisuke Kawamura, Goroh Kawamura, Koji Suzuki, Michio Minami

Institutions: Shinshu University, Hokkaido Orthopedic Surgery Memorial Hospital

Language: English

Topic: Inflammasome and immune disorders

Subfield: Molecular Biology

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: green

Funder: Hospital for Special Surgery