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Familial Mediterranean fever after recovery from Schnlein-Henoch syndrome.

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Familial Mediterranean fever after recovery from
Schonlein-Henoch syndrome
To the Editor:
The clinical similarity between familial Mediterranean fever (FMF) and Schonlein-Henoch syndrome (SHS) is
well known. The simultaneous occurrence of these diseases
has already been reported (Flatau E, Kohn D, Schiller D ,
Lurie M, Levy E: Schonlein-Henoch syndrome in patients
with familial Mediterranean fever. Arthritis Rheum 25:4247, 1982). I would like to report the occurrence of F M F
following recovery from SHS.
An 11-year-old boy had been diagnosed as having
S H S 13 months previously. At that time his symptoms
included abdominal cramps, arthritis, and typical rashes
over the lower extremities. The kidneys were not involved.
Following his recovery from SHS, he suffered recurrent
Pediatric Rheumatology for the Practitioner (Comprehensive
Manuals in Pediatrics). Jerry C . Jacobs. New York. Springer-Verlag, 1982. 556 pages. IlluAtruted. $45.00.
abdominal cramps and fever lasting 12-32 hours; 14 such
attacks occurred in 7 months.
During the last attack, physical examination results
were unremarkable except for fever (39.1"C) and slight
abdominal tenderness. Sedimentation rate and plasma fibrinogen level were 90 m m h o u r and 1,400 mg/dl, respectively.
He was treated with colchicine and, at the time of this
report, has been in remission for 6 months.
The patient described here differs from those in the
literature because F M F appeared after recovery from SHS;
in other reported cases it appeared during the course of SHS.
This case suggests that patients with a history of S H S should
be followed closely for the development of FMF.
Musa Kazim Caglar, MD
Hacettepe Children's Hospital
Ankara, Turkey
Rheumatic Fever: A Guide to its Recognition, Prevention and
Cure with Special Reference to Developing Countries. Angelo
Taranta. MD, Milton Markowitz. MD. Boston, MTP Press,
Ltd., 1981. 96 pages. Illustrated. Indexed. $18.00.
This clinically oriented text is well organized and
readable and well achieves its stated goal: to provide information to family practitioners and pediatricians concerning
the differential diagnosis, physical findings, and therapy in
children with rheumatic disease.
Dr. Jacobs acknowledges that although 2% of all
visits to the pediatrician are for musculoskeletal complaints,
few of these children will be seen o r treated by a pediatric
rheumatologist. Therefore, because of the complexity of the
evaluation of musculoskeletal pain, more than one-third of
the text presents information relating to differential diagnosis. The book covers a wide range of cases encountered in a
pediatric practice, with each chapter supplemented by comprehensive references. Some specific sections deserve special mention: the review of Kawasaki's disease, a predominantly pediatric affliction, is excellent. The final chapter on
"power of positive thinking" demonstrates the rewards of
realistic goal-setting combined with the fighting spirit.
The book contains numerous black and white illustrations (some would have been enhanced by color), and the
graphic material is clearly presented. Throughout the text,
the effects of both disease and therapy on the growth and
development of the child are well detailed. The field of
pediatric rheumatology is a relatively new one, and this text
will provide the physician with the background to assess and
treat his or her patients in an appropriate manner.
This short book is written primarily for medical
students, physicians who are young or, as the authors say
"young in heart at least," and health planners. The book has
12 chapters which cover, in succinct form, all aspects of
rheumatic fever including definitions, etiology, differential
diagnosis, treatment, and the role of health personnel in
prevention programs. The authors, who have spent a lifetime
in the care and investigation of rheumatic fever, quite
correctly point out that it is still a major health problem in
developing countries. They remind us that in certain parts of
the world it is still the most common cause of heart disease in
the 5-30-year age group.
The chapter on etiology, pathogenesis, and pathology contains the basic facts and is obviously not aimed at the
sophisticated investigator. The chapters on clinical manifestations, laboratory tests, and diagnosis are all clearly written
and very easy to understand. The last 3 chapters discuss the
concepts of prevention and how to achieve the best results
with the most efficiency and in the most cost beneficial way.
This small book has 13 tables. 14 figures, and 31
references. Although it obviously does not include some of
the new, exciting immunogenetic information on rheumatic
fever, it is very well written and entirely appropriate for its
potential audience. Since it is so concise and well written, it
is also of value to rheumatologists, particularly those in
training in the western world-it provides a necessary reminder that rheumatic fever does occasionally occur.
Lauren M. Pachman. MD
Northwestern University Medical School
Chicago, IL
Evelyn Hess. MD
University of Cincinnati Medical Center
Cincinnnti, OH
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mediterranean, henoch, recovery, syndrome, feve, schnlein, familiar
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