DOI: 10.12890/2025_005127
An association between MEFV mutation and ANCA-associated vasculitis involving the central nervous system and lungs: causality under scrutiny
Authors
marcusvillander@yahoo.com.br
Keywords
Pyrin, immune dysregulation, ANCA-associated vasculitis, familial Mediterranean feverAbstract
Familial Mediterranean fever (FMF) is traditionally associated with biallelic mutations in the MEFV gene; however, heterozygous mutations may also contribute to disease phenotypes. We report the case of a 42-year-old woman with heterozygous p.Met694Ile MEFV mutation, presenting with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis involving the central nervous system and lungs. Her clinical course was marked by immune dysregulation, autoimmunity and inflammatory manifestations, including urticarial neutrophilic dermatoses and IgM deficiency. This case highlights the potential pathogenic role of heterozygous MEFV mutations in ANCA-associated vasculitis, expanding the clinical spectrum of FMF-related inflammatory diseases. Genetic investigation is essential in patients with overlapping autoimmune and autoinflammatory features to guide appropriate diagnosis and management.
References
- li>Gershoni-Baruch R, Brik R, Shinawi M, Livneh A. The differential contribution of MEFV mutant alleles to the clinical profile of familial Mediterranean fever. Eur J Hum Genet 2002;10:145-149.
- Salehzadeh F, Enteshari Moghaddam A. Coexisting Diseases in Patients with Familial Mediterranean Fever. Open Access Rheumatol 2020;12:65-71.
- Abbara S, Grateau G, Ducharme-Bénard S, Saadoun D, Georgin-Lavialle S. Association of Vasculitis and Familial Mediterranean Fever. Front Immunol. 2019;10:763.
- Schwartz T, Langevitz P, Zemer D, Gazit E, Pras M, Livneh A. Behçet’s disease in Familial Mediterranean Fever: Characterization of the association between the two diseases. Semin Arthritis Rheum 2000;29:286–295.
- Aksu K, Keser G. Coexistence of vasculitides with Familial Mediterranean Fever. Rheumatol Int 2011;31:1263–1274.
- Migita K, Fujita Y, Asano T, Sato S. The Expanding Spectrum of Autoinflammatory Diseases. Intern Med 2023;62:43-50.
- Bernot A, da Silva C, Petit JL, Cruaud C, Caloustian C, Castet V et al. Non-founder mutations in the MEFV gene establish this gene as the cause of familial Mediterranean fever (FMF). Hum Mol Genet 1998;7:1317-1325.
- Abbara S, Monfort JB, Savey L, Moguelet P, Saadoun D, Bachmeyer C et al. Vasculitis and familial Mediterranean fever: Description of 22 French adults from the juvenile inflammatory rheumatism cohort. Front Med (Lausanne). 2022;9:1000167.
- Elhani I, Dumont A, Deshayes S, Georgin-Lavialle S, Giurgea I, Aouba A. Typical Familial Mediterranean Fever associated with the heterozygous missense sequence p.T577N variant of the MEFV gene: Report on two Northern European Caucasians relatives in France. Joint Bone Spine 2020;87:251-255.
- Jéru I, Hentgen V, Cochet E, Duquesnoy P, Le Borgne G, Grimprel E, et al. The Risk of Familial Mediterranean Fever in MEFV Heterozygotes: A Statistical Approach. PLoS One 2013;8:e68431.