Pleural mesothelioma in a patient with Familial Mediterranean Fever: A case report

Our plain-English summary of Pleural mesothelioma in a patient with Familial Mediterranean Fever: A case report, by A. Albtoosh, O.W. Alhasan, M. Alakhras, et al (Qatar Medical Journal, 2026).

The study

• Authors: A. Albtoosh, O.W. Alhasan, M. Alakhras, L. Taweel, B.A.A. Odat, M. Abdaljaleel, H. Abuawad, O.A. Ajamieh, T. Gharaibeh, K. Oweidat, S.A. Sawalhi
• Journal: Qatar Medical Journal
• Published: 2026;2026(1):20
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is a rare, lethal neoplasm of mesothelial surfaces, classically attributed to asbestos exposure. However, as regulations have reduced asbestos use, there is an increased focus on non-asbestos-related causes. Among these, the chronic serosal inflammation characteristic of Familial Mediterranean Fever (FMF) has been reported in a few cases. Although a direct causal relationship has not yet been established, such cases are critical for identifying the potential long-term risks of chronic serosal inflammation. Here, we present the fourth documented case of pleural mesothelioma associated with FMF.

Case Presentation: A 55-year-old male patient with known FMF was admitted to the hospital with progressive shortness of breath and cough for one month. Physical examination and chest X-ray revealed a large left-sided pleural effusion. Thoracocentesis analysis demonstrated an exudative effusion with predominant lymphocytosis. A contrast-enhanced computed tomography (CT) scan showed pleural thickening with enlarged mediastinal lymph nodes. Positron emission tomography (PET) scan revealed avid pleural uptake (SUVmax = 7.5). A pleural biopsy was therefore performed, revealing epithelioid pleural mesothelioma. The patient had no known history of asbestos exposure. However, he was poorly compliant with colchicine treatment and experienced frequent episodes of serositis, occurring on average twice monthly. The patient underwent surgical resection followed by chemotherapy and is doing well 10 months after the initial presentation.

Discussion: Many cases of FMF have been reported in association with peritoneal mesothelioma, but few have been linked to pleural mesothelioma. In this case, we highlight that chronic serosal inflammation, characteristic of untreated FMF, may represent a potential risk factor for non-asbestos-related malignant pleural mesothelioma. Larger-scale registry studies may be required to establish a statistically significant association.

Conclusion: This case reinforces the hypothesis that uncontrolled FMF may predispose patients to malignant mesothelioma. The presence of such an association would further stress the importance of early recognition and management of FMF.

© 2026 Albtoosh, Alhasan, Alakhras, Taweel, Al Odat, Abdaljaleel, et al., licensee HBKU Press.

In plain English

This case report from Jordan University Hospital, Amman, described a 55-year-old man with Familial Mediterranean Fever (FMF), an inherited inflammatory disease, who developed malignant pleural mesothelioma. He carried a homozygous M694V MEFV mutation, took colchicine poorly, and had serositis episodes 2 to 3 times a month. A retired land surveyor and ex-smoker, he had no history of asbestos or silica exposure. He presented with a month of worsening breathlessness and dry cough and a massive left-sided pleural effusion. Five pleural fluid cytology samples were negative for malignancy. A PET scan showed hypermetabolic left pleural thickening, and a thoracoscopic biopsy confirmed epithelioid malignant pleural mesothelioma. He had an extended pleurectomy with left hemidiaphragm resection, then four cycles of carboplatin and pemetrexed, and was started on radiotherapy. He was doing well 10 months after first presenting. The authors called this the fourth reported case of pleural mesothelioma with FMF. They concluded it reinforces the hypothesis that uncontrolled FMF may predispose patients to mesothelioma. They also noted that FMF is not yet definitively established as a risk factor and that larger registry studies may be needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 55-year-old man with Familial Mediterranean Fever, treated at Jordan University Hospital, a tertiary academic center in Amman, Jordan
• Exposure: No history of asbestos or silica exposure (retired land surveyor). The exposure the authors discuss is chronic serosal inflammation from FMF, poorly controlled because of poor colchicine adherence. He was an ex-smoker (one pack daily for 16 years, quit 25 years earlier).
• Main results:
  • The patient's FMF was confirmed genetically as a homozygous M694V mutation in the MEFV gene; he was poorly adherent to colchicine and had serositis episodes 2 to 3 times per month
  • A chest X-ray showed a massive left-sided pleural effusion
  • Cytology of five separate pleural fluid samples was negative for malignancy
  • PET scan showed hypermetabolic nodular thickening of the left lower pleura (SUVmax = 7.5)
  • VATS pleural biopsy confirmed malignant pleural mesothelioma of the epithelioid type; immunohistochemistry was positive for calretinin, D2-40 and WT1
  • An abdominal fat pad biopsy was negative for amyloidosis
  • Treatment was extended pleurectomy and left hemidiaphragm resection with reconstruction, then four cycles of carboplatin and pemetrexed, then radiotherapy
  • The patient was last seen doing well 10 months after initial presentation
• The authors' conclusion: The authors concluded that this case, which they describe as the fourth reported case of pleural mesothelioma in a patient with FMF, reinforces the hypothesis that uncontrolled FMF may predispose patients to malignant mesothelioma
• Limitations the authors state:
  • The authors note that FMF has not yet been definitively established as a risk factor for mesothelioma
  • The authors state that larger registry studies may be needed to establish a statistically significant association

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Neoplasm, Asbestos Exposure, Inflammation, Chest X-Ray, Pleural Effusion, Pleural Thickening.

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