Dilemma between knife and needle for acute abdominal pain in familial Mediterranean fever: Two case reports and literature review.

BACKGROUND

Acute abdominal pain in children often raises concern for surgical emergencies such as appendicitis. However, autoinflammatory disorders, including familial Mediterranean fever (FMF), may mimic acute abdomen, leading to diagnostic confusion and potentially unnecessary surgeries.

CASE SUMMARY: We present two contrasting pediatric cases, both of whom initially presented with acute right lower quadrant abdominal pain and tenderness. The first was a 5.5-year-old girl with fever who underwent appendectomy despite no sonographic evidence of appendicitis, yet her clinical score (Alvarado score) was highly suggestive of appendicitis. The second was a 5.5-year-old boy who was afebrile but had abdominal sonographic findings of a slightly inflamed appendix. He improved with conservative management and intravenous antibiotics. Upon second presentation, both were ultimately diagnosed with FMF.

CONCLUSION

FMF can mimic appendicitis in children; careful history, clinical suspicion, and judicious imaging help prevent unnecessary surgery during acute attacks.