Sira AM, Shoeir SA, Sira MM. Dilemma between knife and needle for acute abdominal pain in familial Mediterranean fever: Two case reports and literature review. World J Clin Pediatr 2026; 15(2): 117377 [DOI: 10.5409/wjcp.v15.i2.117377]
Corresponding Author of This Article
Mostafa M Sira, MD, Professor, Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Gamal Abdel Nasser Street, Shebin El-Koom 32511, Menoufia, Egypt. msira@liver.menofia.edu.eg
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Pediatrics
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Case Report
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Jun 9, 2026 (publication date) through May 16, 2026
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World Journal of Clinical Pediatrics
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2219-2808
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Sira AM, Shoeir SA, Sira MM. Dilemma between knife and needle for acute abdominal pain in familial Mediterranean fever: Two case reports and literature review. World J Clin Pediatr 2026; 15(2): 117377 [DOI: 10.5409/wjcp.v15.i2.117377]
World J Clin Pediatr. Jun 9, 2026; 15(2): 117377 Published online Jun 9, 2026. doi: 10.5409/wjcp.v15.i2.117377
Dilemma between knife and needle for acute abdominal pain in familial Mediterranean fever: Two case reports and literature review
Ahmed M Sira, Samar A Shoeir, Mostafa M Sira
Ahmed M Sira, Department of Pediatrics, Tanta General Hospital, Egyptian Ministry of Health and Population, Tanta 31511, Al Gharbīyah, Egypt
Samar A Shoeir, Mostafa M Sira, Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Shebin El-Koom 32511, Menoufia, Egypt
Co-first authors: Ahmed M Sira and Samar A Shoeir.
Author contributions: Sira AM contributed to conceptualization, data curation, investigation, methodology, project administration, supervision, follow-up, and writing of the original draft; Shoeir SA contributed to conceptualization, investigation, methodology, follow-up, and writing of the original draft; Sira MM contributed to conceptualization, investigation, methodology, and writing of the original draft; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the participants’ legal guardians for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mostafa M Sira, MD, Professor, Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Gamal Abdel Nasser Street, Shebin El-Koom 32511, Menoufia, Egypt. msira@liver.menofia.edu.eg
Received: December 8, 2025 Revised: January 7, 2026 Accepted: January 22, 2026 Published online: June 9, 2026 Processing time: 159 Days and 0.1 Hours
Abstract
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.
Core Tip: Children with familial Mediterranean fever (FMF) can present with acute abdominal attacks that resemble acute appendicitis. Diagnostic discrimination is challenging due to mimicry in clinical, laboratory, and even some radiological findings. We present two children with acute abdominal pain: One was managed surgically despite the lack of radiological evidence of appendicitis. By contrast, the other was managed conservatively despite radiological findings of a slightly inflamed appendix. Both were ultimately diagnosed with FMF. This highlights the importance of differentiating the causes of acute abdominal pain by maintaining a high index of suspicion for FMF, particularly in endemic areas of the Mediterranean basin.
