Familial mediterranean fever physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash.

• 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 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 examination of patients with familial Mediterranean fever is usually normal.

• 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.^[4]

• 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

• Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings:^[5]
• Chest tenderness upon palpation due to pericarditis
• Friction rub

• Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.^[6]
• Hepatomegaly / splenomegaly / hepatosplenomegaly may also be present.
• Other possible causes of an acute abdomen should be ruled out.

• Back examination of patients with familial Mediterranean fever is usually normal.
• Signs of sacroileitis such may be present.^[7][8]

• 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.^[9][10][11]
• Testicular torsion must always be ruled out.

• 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.^[12]

• FMF usually affects large joints of lower extremity and signs of inflammation may be present.^[7]
• The small joints of the hands can also be involved.