Progressive bouts of acute abdomen: Pet the peritoneum

The recent discovery of the mutated gene responsible for Familial Mediterra nean Fever (FMF) is supposed to facilitate its diagnosis which up till now is a clinical one because there are no specific laboratory tests. The sensi tivity of genetic testing is limited because these tests search only for kn own mutations. In this case report we describe a patient with periodic abdominal pain in w hom the diagnosis of FMF was wrongly discarded because of lack of a durable effect of colchicine and negative genetic testing. Diffuse peritoneal infl ammation was nicely demonstrated by a FDG-PET (fluoro-deoxy-glucose positro n-emission tomography) performed during a typical crisis. We discuss the po ssible diagnostic pitfalls and conclude that a crisis-PET might upgrade the level of diagnostic certainty in equivocal cases.