Familial Mediterranean fever presenting as recurrent acute pelvic inflammatory disease

Background: Recurrent acute episodes of pelvic inflammatory disease (PID) often present a diagnostic dilemma. The differential diagnosis should include reinfection, appendicitis, endometriosis, irritable bowel syndrome, colitis, persistent ovarian cyst, and antibiotic-resistant bacterial strains. Case: A young Palestinian woman presented with recurrent episodes of pelvic pain with rebound tenderness, fever, and elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. The patient underwent extensive workup, multiple courses of intravenous and oral antibiotics, and diagnostic laparoscopies, with continued recurrent episodes. Treatment with colchicine for suspected familial Mediterranean fever resulted in resolution of symptoms. Conclusion: In patients of Mediterranean ancestry who have symptoms of recurrent PID that are refractory to conventional treatment, familial Mediterranean fever should be included in the differential diagnosis.