Long-term familial Mediterranean fever remission on successful hepatitis C virus treatment in a patient not responding to colchicine: a case report

Manik Gemilyan, Gagik Hakobyan, Susanna Ananyan

Familial Mediterranean fever is an autosomal recessive disorder characterized by periodic febrile attacks of aseptic serositis and/or arthritis. The main treatment is colchicine which prevents attacks in the majority of patients except for a group of colchicine-resistant cases. Chronic hepatitis C is a viral infection causing chronic inflammation of liver tissue (hepatitis) which ultimately progresses to fibrosis and liver cirrhosis with a high chance of hepatocellular carcinoma. However, we found no data in the literature concerning the impact of hepatitis C on the course of attacks of familial Mediterranean fever. We report a case of a 21-year-old white woman with familial Mediterranean fever who had not been responding to a high dose of colchicine (2 mg/day). She presented to our clinic with a finding of chronic hepatitis C genotype 3 infection. After successful antiviral therapy with peginterferon and ribavirin, she became attack-free for 2 years and went on to a lower dose of colchicine. This unusual case illustrates complete resolution of attacks of autoinflammatory disease after drug-induced clearance of chronic hepatitis C infection. Coexisting infections should be viewed as potentially altering the course of autoinflammatory disorders, and any attempt to cure the infections should be made in order to gain an added value of benefiting the chronic disease. This case highlights the interrelation of external pathogen-related and genetically inherited alterations in immunity and the importance of considering the whole spectrum of possible causative factors rather than implementing separate guidelines in order to achieve best quality of medical care in any given patient.