Familial mediterranean fever physical examination: Difference between revisions
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* Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present. | * Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present. | ||
*Potential skin lesions include: | *Potential skin lesions include: | ||
* Erysipelas like erythema: painful, red-colored, and hyperthermic skin lesion often located at the shin or foot region.<ref name="pmid22243424">{{cite journal |vauthors=Lidar M, Doron A, Barzilai A, Feld O, Zaks N, Livneh A, Langevitz P |title=Erysipelas-like erythema as the presenting feature of familial Mediterranean fever |journal=J Eur Acad Dermatol Venereol |volume=27 |issue=7 |pages=912–5 |date=July 2013 |pmid=22243424 |doi=10.1111/j.1468-3083.2011.04442.x |url=}}</ref> | |||
* Purpuric rash<ref name="pmid2217666">{{cite journal |vauthors=Majeed HA, Quabazard Z, Hijazi Z, Farwana S, Harshani F |title=The cutaneous manifestations in children with familial Mediterranean fever (recurrent hereditary polyserositis). A six-year study |journal=Q. J. Med. |volume=75 |issue=278 |pages=607–16 |date=June 1990 |pmid=2217666 |doi= |url=}}</ref> | |||
* Angioneurotic edema | |||
* Diffuse erythema of palms and soles | |||
* Skin peeling | |||
* Raynaud’s phenomenon | |||
* Subcutaneous nodule | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with familial Mediterranean fever is usually normal. | * HEENT examination of patients with familial Mediterranean fever is usually normal. | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as: | * Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as: | ||
*[[Lymphadenopathy]] which may be with/without pain | *[[Lymphadenopathy]] which may be with/without pain. | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with familial Mediterranean fever may be positive for:<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | * Pulmonary examination of patients with familial Mediterranean fever may be positive for:<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | ||
*Lungs are hyporesonant due to associated pleural effusion | *Lungs are hyporesonant due to associated pleural effusion | ||
*Normal/reduced [[tactile fremitus]] | *Normal/reduced [[tactile fremitus]] | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings: | * Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings:<ref name="pmid415347">{{cite journal |vauthors=Bartolucci S |title=[Presence of lens antigens on the level of chicken-liver membranes during development] |language=Italian |journal=Riv. Biol. |volume=70 |issue=1-2 |pages=49–76 |date=1977 |pmid=415347 |doi= |url=}}</ref> | ||
*Chest tenderness upon palpation due to pericarditis | *Chest tenderness upon palpation due to pericarditis | ||
*[[Friction rub]] | *[[Friction rub]] | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.<ref name="pmid17240429">{{cite journal |vauthors=Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E |title=Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent? |journal=Semin. Arthritis Rheum. |volume=36 |issue=5 |pages=316–21 |date=April 2007 |pmid=17240429 |doi=10.1016/j.semarthrit.2006.11.002 |url=}}</ref> | * Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.<ref name="pmid17240429">{{cite journal |vauthors=Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E |title=Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent? |journal=Semin. Arthritis Rheum. |volume=36 |issue=5 |pages=316–21 |date=April 2007 |pmid=17240429 |doi=10.1016/j.semarthrit.2006.11.002 |url=}}</ref> | ||
* [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may also be present. | * [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may also be present. | ||
* Other possible causes of an acute abdomen should be ruled out. | * Other possible causes of an acute abdomen should be ruled out. | ||
===Back=== | ===Back=== | ||
* Back examination of patients with familial Mediterranean fever is usually normal. | * Back examination of patients with familial Mediterranean fever is usually normal. | ||
* Signs of sacroileitis such may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref><ref name="pmid18795391">{{cite journal |vauthors=Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C |title=The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis |journal=Clin. Rheumatol. |volume=28 |issue=1 |pages=41–6 |date=January 2009 |pmid=18795391 |doi=10.1007/s10067-008-0980-3 |url=}}</ref> | * Signs of sacroileitis such may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref><ref name="pmid18795391">{{cite journal |vauthors=Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C |title=The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis |journal=Clin. Rheumatol. |volume=28 |issue=1 |pages=41–6 |date=January 2009 |pmid=18795391 |doi=10.1007/s10067-008-0980-3 |url=}}</ref> | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with familial Mediterranean fever is usually normal. | * Genitourinary examination of patients with familial Mediterranean fever is usually normal. | ||
* Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.<ref name="pmid1456246">{{cite journal |vauthors=Gedalia A, Mordehai J, Mares AJ |title=Acute scrotal involvement in children with familial Mediterranean fever |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1419–20 |date=December 1992 |pmid=1456246 |doi= |url=}}</ref><ref name="pmid10663841">{{cite journal |vauthors=Majeed HA, Ghandour K, Shahin HM |title=The acute scrotum in Arab children with familial Mediterranean fever |journal=Pediatr. Surg. Int. |volume=16 |issue=1-2 |pages=72–4 |date=2000 |pmid=10663841 |doi= |url=}}</ref><ref name="pmid8044614">{{cite journal |vauthors=Eshel G, Vinograd I, Barr J, Zemer D |title=Acute scrotal pain complicating familial Mediterranean fever in children |journal=Br J Surg |volume=81 |issue=6 |pages=894–6 |date=June 1994 |pmid=8044614 |doi= |url=}}</ref> | * Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.<ref name="pmid1456246">{{cite journal |vauthors=Gedalia A, Mordehai J, Mares AJ |title=Acute scrotal involvement in children with familial Mediterranean fever |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1419–20 |date=December 1992 |pmid=1456246 |doi= |url=}}</ref><ref name="pmid10663841">{{cite journal |vauthors=Majeed HA, Ghandour K, Shahin HM |title=The acute scrotum in Arab children with familial Mediterranean fever |journal=Pediatr. Surg. Int. |volume=16 |issue=1-2 |pages=72–4 |date=2000 |pmid=10663841 |doi= |url=}}</ref><ref name="pmid8044614">{{cite journal |vauthors=Eshel G, Vinograd I, Barr J, Zemer D |title=Acute scrotal pain complicating familial Mediterranean fever in children |journal=Br J Surg |volume=81 |issue=6 |pages=894–6 |date=June 1994 |pmid=8044614 |doi= |url=}}</ref> | ||
* Testicular torsion must always be ruled out. | * Testicular torsion must always be ruled out. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with familial Mediterranean fever is usually normal. | * Neuromuscular examination of patients with familial Mediterranean fever is usually normal. | ||
* Patient is usually oriented to persons, place, and time. | * Patient is usually oriented to persons, place, and time. | ||
* | * Focal neurological signs may also be present.<ref name="KalyoncuEker2010">{{cite journal|last1=Kalyoncu|first1=Umut|last2=Eker|first2=Amber|last3=Oguz|first3=Kader K.|last4=Kurne|first4=Asli|last5=Kalan|first5=Isilay|last6=Topcuoglu|first6=Akif M.|last7=Anlar|first7=Banu|last8=Bilginer|first8=Yelda|last9=Arici|first9=Mustafa|last10=Yilmaz|first10=Engin|last11=Kiraz|first11=Sedat|last12=Calguneri|first12=Meral|last13=Karabudak|first13=Rana|title=Familial Mediterranean Fever and Central Nervous System Involvement|journal=Medicine|volume=89|issue=2|year=2010|pages=75–84|issn=0025-7974|doi=10.1097/MD.0b013e3181d5dca7}}</ref> | ||
===Extremities=== | ===Extremities=== | ||
* FMF usually affects large joints of lower extremity and signs of inflammation may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref> | * FMF usually affects large joints of lower extremity and signs of inflammation may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref> | ||
* The small joints of the hands can also be involved. | * The small joints of the hands can also be involved. | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash.
Physical Examination
- Physical examination of patients with familial Mediterranean fever in periods between attacks is usually normal.[1]
- During attacks, common physical examination findings include fever, arthritis, and skin rash.
- Tachypnea and tachycardia may be present due to the effect of fever.
- Fever is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more.
Skin
- Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present.
- Potential skin lesions include:
- Erysipelas like erythema: painful, red-colored, and hyperthermic skin lesion often located at the shin or foot region.[2]
- Purpuric rash[3]
- Angioneurotic edema
- Diffuse erythema of palms and soles
- Skin peeling
- Raynaud’s phenomenon
- Subcutaneous nodule
HEENT
- HEENT examination of patients with familial Mediterranean fever is usually normal.
Neck
- Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as:
- Lymphadenopathy which may be with/without pain.
Lungs
- Pulmonary examination of patients with familial Mediterranean fever may be positive for:[1]
- Lungs are hyporesonant due to associated pleural effusion
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings:[4]
- Chest tenderness upon palpation due to pericarditis
- Friction rub
Abdomen
- Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.[5]
- Hepatomegaly / splenomegaly / hepatosplenomegaly may also be present.
- Other possible causes of an acute abdomen should be ruled out.
Back
- Back examination of patients with familial Mediterranean fever is usually normal.
- Signs of sacroileitis such may be present.[6][7]
Genitourinary
- Genitourinary examination of patients with familial Mediterranean fever is usually normal.
- Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.[8][9][10]
- Testicular torsion must always be ruled out.
Neuromuscular
- Neuromuscular examination of patients with familial Mediterranean fever is usually normal.
- Patient is usually oriented to persons, place, and time.
- Focal neurological signs may also be present.[11]
Extremities
- FMF usually affects large joints of lower extremity and signs of inflammation may be present.[6]
- The small joints of the hands can also be involved.
References
- ↑ 1.0 1.1 Flynn AE, Peters MJ, Morgan LC (2013). "Attitudes towards Lung Cancer Screening in an Australian High-Risk Population". Lung Cancer Int. 2013: 789057. doi:10.1155/2013/789057. PMID 26316943.
- ↑ Lidar M, Doron A, Barzilai A, Feld O, Zaks N, Livneh A, Langevitz P (July 2013). "Erysipelas-like erythema as the presenting feature of familial Mediterranean fever". J Eur Acad Dermatol Venereol. 27 (7): 912–5. doi:10.1111/j.1468-3083.2011.04442.x. PMID 22243424.
- ↑ Majeed HA, Quabazard Z, Hijazi Z, Farwana S, Harshani F (June 1990). "The cutaneous manifestations in children with familial Mediterranean fever (recurrent hereditary polyserositis). A six-year study". Q. J. Med. 75 (278): 607–16. PMID 2217666.
- ↑ Bartolucci S (1977). "[Presence of lens antigens on the level of chicken-liver membranes during development]". Riv. Biol. (in Italian). 70 (1–2): 49–76. PMID 415347.
- ↑ Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E (April 2007). "Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent?". Semin. Arthritis Rheum. 36 (5): 316–21. doi:10.1016/j.semarthrit.2006.11.002. PMID 17240429.
- ↑ 6.0 6.1 Majeed HA, Rawashdeh M (January 1997). "The clinical patterns of arthritis in children with familial Mediterranean fever". QJM. 90 (1): 37–43. doi:10.1093/qjmed/90.1.37. PMID 9093587.
- ↑ Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C (January 2009). "The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis". Clin. Rheumatol. 28 (1): 41–6. doi:10.1007/s10067-008-0980-3. PMID 18795391.
- ↑ Gedalia A, Mordehai J, Mares AJ (December 1992). "Acute scrotal involvement in children with familial Mediterranean fever". Am. J. Dis. Child. 146 (12): 1419–20. PMID 1456246.
- ↑ Majeed HA, Ghandour K, Shahin HM (2000). "The acute scrotum in Arab children with familial Mediterranean fever". Pediatr. Surg. Int. 16 (1–2): 72–4. PMID 10663841.
- ↑ Eshel G, Vinograd I, Barr J, Zemer D (June 1994). "Acute scrotal pain complicating familial Mediterranean fever in children". Br J Surg. 81 (6): 894–6. PMID 8044614.
- ↑ Kalyoncu, Umut; Eker, Amber; Oguz, Kader K.; Kurne, Asli; Kalan, Isilay; Topcuoglu, Akif M.; Anlar, Banu; Bilginer, Yelda; Arici, Mustafa; Yilmaz, Engin; Kiraz, Sedat; Calguneri, Meral; Karabudak, Rana (2010). "Familial Mediterranean Fever and Central Nervous System Involvement". Medicine. 89 (2): 75–84. doi:10.1097/MD.0b013e3181d5dca7. ISSN 0025-7974.