My Child Has Constant Fever: Relapsing Fever Syndromes (PFAPA and Others)
🎯 “He has the same fever almost every month, but nothing clear comes up in any tests…”
This phrase, frequently uttered by parents, is one of the distinguishing signs of relapsing fever syndromes. Especially in children between the ages of 6 months and 6 years, these conditions, which start like an infection but are actually related to the overwork of the immune system, fall into the group of auto-inflammatory diseases.
In this article, we share what you need to know about the most common syndromes, PFAPA, Familial Mediterranean Fever (FMF) and other periodic fever syndromes.
📌What is PFAPA Syndrome?
PFAPA is the most common periodic fever syndrome in children. It stands for:
• P: Periodic (at certain intervals)
• F: Fever
• A: Aphthous stomatitis (sores in the mouth)
• P: Pharyngitis (inflammation of the throat)
• A: Adenitis (swelling in neck lymph nodes)
🧩 Features:
✅ High fever attacks that recur every 3-6 weeks
✅ Usually, each attack starts in the same way and passes spontaneously within 3-5 days.
✅ Other than fever, the child is generally healthy
✅ Completely fine between attacks
✅ No improvement with antibiotics
🤒 The most common symptoms:
• Sudden onset of high fever
• Sore throat, swollen lymph nodes
• Canker sores in the mouth
• Weakness, loss of appetite
🔬 What are the reasons?
Although the cause of PFAPA is not known for certain, it is the periodic triggering of the inflammatory response in the body as a result of the irregular functioning of the immune system. There is no infection or microbial cause.
There is often no genetic transmission, in this respect it differs from hereditary syndromes such as Familial Mediterranean Fever.
🧪 How to Diagnose?
✅ There is no specific test for the diagnosis of PFAPA syndrome. Diagnosis is usually made by clinical history.
✅ However, diseases such as recurrent infections, immune deficiency and FMF should be excluded.
✅ Your doctor may request the following tests:
• Complete blood count
• CRP, Sedim (inflammation markers)
• Throat culture
• FMF genetic test if necessary
💊 How is Treatment Done?
1. Supportive treatment in fever attacks (fever reducers)
2. The attack may resolve quickly with a single dose of corticosteroid (e.g. prednisolone).
3. In frequent attacks: some children may be offered low-dose colchicine or immunomodulatory treatments
4. In rare cases, removal of tonsils (tonsillectomy) may be recommended
🔄
Other Periodic Fever Syndromes That May Be Confused with PFAPA:
📌 These syndromes should be followed by pediatric rheumatology.
👨⚕️ When to Consult a Doctor?
• Similar recurring fevers more than once a month
• Fever that does not respond to antibiotics
• Recurrent complaints other than fever, such as sore throat, mouth sores, and swollen lymph nodes.
• If there is a family history of genetic diseases such as FMF
📌 Result
Not every fever means infection. If your child has fever attacks at regular intervals that start in a similar way and resolve spontaneously, evaluation for recurrent fever syndromes is required.
🩺 If your child in Izmir has such recurrent fever attacks, I would be happy to welcome you to my office for detailed evaluation and guidance.
