Patient 1, a 21-year-old Greek–Cypriot woman, who carried
the MEFV p.[Val726Ala] and NLRP3 p.[Val198Met]
mutations was initially evaluated due to frequent episodes of
abdominal pain with no associated pyrexial episodes (figure
1a; table 2). The first episode was reported at the age of 3.5
years and was characterized by intense abdominal pain, vomiting,
adenopathy and urticaria. She had no accompanying
fever or any other signs of viral or bacterial infection. She
Figure 1. (a, b and c) With three genealogical trees and the
mutations inherited by each family member.
had lower abdominal tenderness and elevated inflammatory
markers. She was treated with intravenous fluids and was discharged
when symptoms resolved. Between the age 3.5 and
6 years she had cyclical (2–3 monthly) similar episodes of
abdominal pain with vomiting, with or without urticaria but
again with no fever. At the age of 4.5 years, she underwent
a tonsillectomy and at the age of 6 years, an appendectomy
for acute abdominal pain and lower diffuse lower abdominal
tenderness. In her adolescence and later she had no recurrent
episodes apart from lower abdominal pains especially
during menstruation. She was never treated with colchicine
and by far, she has not developed any systemic complications
associated with FMF.