PFAPA: A Pediatric Case Study

Background: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is an autoinflammatory condition theorized to be due to cytokine dysfunction. The presentation of PFAPA is commonly characterized by recurrent fevers in pediatric patients usually between the ages of 1 and 4. Case Information: A 2-year-old Caucasian male accompanied with his mother presented to the pediatric clinic due to high fever. The fever started the morning before and persisted till the next day, reaching a maximum temperature of 105.1°F. The patient was given Motrin and Tylenol in addition to a lukewarm bath, all of which helped abate the fever to 102°F. The patient has a past history of unexplained high fever episodes three times within the past year. At the clinic, the influenza and strep test were negative. The patient was sent home with advised rest and continued Tylenol or Motrin to help control fevers. Patient returned to clinic four days later with persistent fever. The ESR and CRP returned elevated at 19 and 97.6 respectively. Patient was sent home with steroids due to suspected PFAPA. A chest X-ray, urine analysis and culture, and a respiratory PCR were ordered but all returned negative. The next morning, patient went to the ED due to a low temperature of 94.3°F reported by mother. The temperature normalized upon arrival to the ED. Patient was subsequently discharged due to resolution of fevers. Conclusions: This case presents a case of recurrent fevers of unknown etiology suspected to be secondary to PFAPA.