Is it a two variable equations?: a rare association of familial mediterranean fever and celiac disease

Abstract

Objective: We present a 15-year-old male patient with a diagnosis of Familial Mediterranean Fever followed up for 6 years, then diagnosed with also Celiac disease.

Case: The patient with Familial Mediterranean Fever (FMF) was admitted to the pediatric emergency unit many times in the last month with the complaint of recurrent widespread and epigastric pain. Acute phase reactants were in normal range in nearly half of his admissions. Since he had a family history of Celiac disease, at the age of 10, he was referred for Celiac disease serology exmination, but the result was normal. Due to the presence of severe epigastric tenderness and pain at the last visit, gastroduodenoscopy was performed and multiple biopsies were obtained. After gastroduodenoscopy procedure, tissue transglutaminase (tTG) antibody IgA level was reanalysed and the result was >300 U/ml. The pathology result was also consistent with Celiac disease.

Conclusion: The diagnosis of Celiac disease is difficult in patients with FMF because both of them have similar clinical symptoms. Even if previous screening is negative for Celiac disease as in this case, Celiac disease should be considered as it may cause delay in diagnosis, particularly in patients with Familial Mediterranean Fever who have similar symptoms and a positive family history for celiac disease.