Familial Mediterranean Fever (FMF) is a hereditary disease. Recurrent peritonitis is one of the chief manifestations of FMF. Peritonitis attacks are often indistinguishable from those of abdominal surgery and may lead to one or more surgical procedures before diagnosis of FMF. Meningitis in patients with FMF is rare.

  The present report refers a 28-year-old man with recurrent attacks of peritonitis who had 2 abdominal surgeries and one attack of meningitis. Clinical diagnosis of FMF based on clinical history was made. After colchicine therapy, during 3 years follow up, just two mild attacks of abdominal pain but no further recurrence of meningitis was observed. Therefore, definite diagnosis of FMF based on Tel-Hashomer criteria was considered.

  The present case has three suggestions: one is that each abdominal attack of FMF patients may lead to an unnecessary laparotomy prior to diagnosis of FMF. The second is that FMF patients can present with mild abdominal pain while they are receiving colchicine, and the third is that meningitis should be considered as an unusual manifestation of FMF with excellent response to colchicine therapy.