We were recently involved in the management of a 38-year-old male who was admitted to our hospital for an elective surgical procedure that mandated general anaesthesia. He was also known to suffer with Familial Mediterranean Fever (FMF). FMF is a hereditary inflammatory disease characterised by self-limited recurrent attacks of fever and serositis . The recurrent attacks of fever are accompanied by severe abdominal pain, arthritis or chest pain along with a marked increase in acute phase reactants . Inheritance is autosomal recessive and it affects mainly Jews, Turks, Arabs and Armenians . FMF crises are characterised by an influx of polymorphonuclear leucocytes into the inflamed regions .
A PubMed search uncovered that attacks could be precipitated by intravenous metaraminol . Indeed, the metaraminol provocative test is considered a specific diagnostic test for FMF: a 10-mg infusion of metaraminol is followed within 48 h by a typical disease-like attack . As metaraminol is widely used in anaesthetic practice and cumulative doses in excess of 10 mg can be administered if hypotension is protracted, it is quite likely this could trigger a FMF crisis postoperatively. The metaraminol-induced symptoms do not occur in patients on prophylactic colchicine therapy . However, colchicine treatment is often complicated by frequent gastrointestinal side-effects, reducing patient compliance . We would therefore suggest anaesthetists remain vigilant to the potential risks associated with the use of metaraminol in this group of patients, especially those not taking colchicine regularly.