Colchicine-resistant familial Mediterranean fever in a renal transplantation patient: successful treatment with anakinra

Familial Mediterranean fever (FMF) is an autosomal recessively inherited autoinflammatory disease characterized by recurrent fever, abdominal pain and arthritis. It is common in Turks, Arabs and non-Ashkenazi Jews, and uncontrolled disease can result in AA amyloidosis [1]. Colchicine is a microtubule -depolymerizing drug widely used in the treatment of gout arthritis and in the prevention of FMF attacks and development of secondary amyloidosis. Although colchicine is a very effective drug in preventing FMF attacks, ∼5–15% of FMF patients are resistant to regular colchicine treatment and have recurrent attacks [2]. These patients have been treated with alternative adjunctive treatments such as thalidomide, etanercept, interferon alpha and anakinra to suppress autoinflammation [3]. Herein, we present a patient with colchicine-resistant FMF attacks after living-unrelated kidney transplantation. The patient became attack free with the initiation of anakinra, an interleukin (IL)-1 receptor (IL-1R) antagonist, as an adjunctive treatment.