PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome in children; surgical versus medical treatment?

Abstract

PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical lymphadenopathy) syndrome usually presents in childhood and one of the most common periodic fever syndromes. The syndrome is self-limitted, characterized by periodic fevers at regular intervals and standard clinical features of pharyngitis, aphtous ulcers and cervical lympadenitis. The diagnosis is based upon clinical criteria with the exclusion of other recurrent fever causes. The treatment of PFAPA syndrome is divided two parts; to control of the acute attacks and to decrease the frequency of the attacks. In this retrospective study we aimed to compare the indications and efficiency of medical versus surgical treatment in children with PFAPA syndrome. Forty-five children with PFAPA syndrome whom treated with surgical or medical options were included and divided into two groups. The recovery rates before and after treatments were statistically analyzed. In both groups symptomatic improvement were seen. In surgical and medical treatment groups, complete clinical recovery was found 80% and 74%, respectively. Besides, statistically significant reduction in frequency (p<0.05) and duration (p<0.05) of recurrences in the incomplete clinical recovery cases were seen. Similar to literature our results support that both medical and surgical treatment are effective treatment methods. Surgery is a preferable treatment option especially in patients who do not response to medical treatment. The optimal strategy for management is depend on response to treatments.