The Five-Year Abdominal Pain Conundrum- A Bizarre Case of Secondary Amyloidosis

Amyloidosis is a vast group of diseases associated with a number of inherited and inflammatory disorders which is marked by extracellular fibrillar proteins leading to tissue damage. There are various biochemical types of amyloid proteins which along with the clinical signs are used in classifying this condition into- AL Amyloidosis, A Beta Amyloidosis, AA Amyloidosis, AE amyloidosis so on and so forth. Amyloidosis is usually diagnosed by demonstrating amyloid deposits in the tissues by various diagnostic modalities like pathological and immunohistochemical studies. The management of amyloidosis involves symptomatic treatment and targeting the underlying cause. Ideally, prompt diagnosis and treatment of the underlying cause can prevent the development of secondary amyloidosis. Timely intervention and management of amyloidosis will improve the quality of the patient’s life. Informed consent obtained from patient guardians. A 31yr old male from Tamil Nadu had experienced several episodes of fever and abdominal pain on and off for almost five and a half years. He underwent various investigations throughout those years starting with baseline investigations such as CBC, ESR, CRP, etc. to high end investigations like bone marrow biopsy and renal needle biopsy. He underwent several other procedures like diagnostic laparoscopy of abdomen and right hemicolectomy. He was then suspected to have secondary amyloidosis with familial mediterranean fever as the probable underlying cause. After all those years of symptomatic management, he was started on colchicine along with steroid and was advised gene study by the end of the year 2008. Years of delay in arriving to a final diagnosis led to his premature demise. We report a case of secondary amyloidosis in which familial Mediterranean fever is most likely the underlying aetiology. When treating recurrent episodes of abdominal pain with fever, it is crucial to understand the significance of FMF as a differential diagnosis, despite its rarity.