Familial Mediterranean Fever Presenting with Recurrent Abdominal Pain without Periodic Fever Following COVID-19

Familial Mediterranean fever (FMF) rarely presents without a periodic fever. We report the case of a 16-year-old girl who developed recurrent abdominal pain after coronavirus disease 2019 without fever. The initial evaluation, including endoscopy, was unremarkable, except for mildly elevated fecal calprotectin (182.1 μg/g). On readmission, peritoneal signs, mild pleural effusion, and elevated serum amyloid A (113.9 mg/L) were noted, while the C-reactive protein level remained normal. Colchicine promptly suppressed these attacks. MEFV sequencing revealed a homozygous E148Q mutation, supporting an atypical FMF. Fecal calprotectin and serum amyloid A levels normalized within one month. This case underscores the importance of FMF in post-infectious recurrent abdominal pain and highlights targeted biomarkers and genetics for making a timely diagnosis.