A CAUSE OF PERIODIC FEVER

Case Report A man, born in 1900, was admitted to St. Bartholomew's Hospital in 1959 for the investigation of an illness in which periodic fever and proteinuria became dominant features. He had lived in England all his life, and had been at work up to the time of his admission. His father, an Italian of non-Jewish stock, had married an Englishwoman and had died of Bright's disease when aged 29. No significant illness had affected his mother, his five siblings, or his two daughters, aged 22 and 21. In 1939 he had an appendicectomy, and when a haematemesis followed this operation a partial gastrectomy was done. In 1955 he noticed slight slurring of speech, followed two years later by some tremor of the arms and legs. His gall-bladder, removed in 1957, contained calculi. No unusual features were found in hospital records apart from a blotchy skin rash noted during an attack of pain presumed to be due to cholecystitis. His urine had been tested on many occasions, but was normal apart from a single record of slight proteinuria during 1957. He attended a clinic in 1955 with pain in the hands, and in 1956 with painful red swellings of hands, feet, and knees, but no diagnosis was made. In May, 1959, he was admitted to hospital after a few days* pain in the lower back and in the right side of the chest, unaffected by breathing, and associated with fever and night sweats. Although it was not realized at this time, he had been subject to attacks of fever with scattered pains since childhood, at first every few months but latterly more frequently. He was well in between attacks and would take only a few days off work. He had not complained of these attacks, and this history was obtained subsequently from his wife.