Familial mediterranean fever physical examination
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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.