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Treating Familial Mediterranean Fever with Prazosin Hydrochloride
- Hideki Kataoka, MD;
- Hiromichi Kumagai, MD; and
- Hiroyuki Hanai, MD
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TO THE EDITOR:
The cause of familial Mediterranean fever (FMF), a recurrent polyserositis, has long been controversial. Recent studies [1, 2] have shown that intravenous administration of metaraminol can provoke FMF, whereas reserpine can suppress such symptoms as fever and abdominal pain [3]. This evidence suggests that abnormal catecholamine metabolism could play a role in the pathogenesis of FMF. On the basis of these facts, we tested the effectiveness of the α-adrenergic receptor antagonist prazosin hydrochloride for preventing attacks of FMF.
A 36-year-old Japanese man who had had self-limited recurrent chest and abdominal pain and high fever every 1 to 2 months for 16 years was admitted to our hospital with a temperature of more than 38 °C and an acute abdomen. These symptoms spontaneously resolved within a few days. All gastrointestinal investigations produced negative results. Metaraminol administration and a cold pressor test induced febrile attack and abdominal pain, whereas colchicine alleviated these symptoms dramatically [4]. Familial Mediterranean fever was diagnosed. Among the reported preventive therapeutic regimens, long-term colchicine administration can induce bone marrow suppression and azoospermia, and reserpine can cause depression. Because an attack of FMF may be attributable to abnormal catecholamine metabolism, we administered the less harmful agent, prazosin hydrochloride (3 mg/d), after obtaining consent from the patient, who had neither cardiovascular disorders nor hypotension. No attacks have occurred for more than 1 year since the start of this treatment, but discontinuation of prazosin therapy resulted in recurrence of the attacks (Figure 1).
In summary, we successfully prevented exacerbations of FMF by administering an α-adrenergic receptor blocking agent. This agent can be used for the long term with few side effects, and it may be useful for preventing secondary amyloidosis [5].
Hideki Kataoka, MD
Hiromichi Kumagai, MD
Hiroyuki Hanai, MD
Hamamatsu University School of Medicine; Hamamatsu, Japan
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
