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Diagnosing PFAPA during the COVID-19 era: clarity during quarantine
  1. Theresa Fiorito1,2,
  2. Meredith Akerman3,
  3. Asif Noor1,2,
  4. Leonard R Krilov1,2
  1. 1 Pediatrics, NYU Langone Health, New York, New York, USA
  2. 2 NYU Long Island School of Medicine, Mineola, New York, USA
  3. 3 Biostatistics, NYU Langone Health, New York, New York, USA
  1. Correspondence to Dr Theresa Fiorito, Pediatrics, NYU Langone Health, New York, NY 11501, USA; theresa.fiorito{at}

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Periodic fever accompanied by aphthous stomatitis, pharyngitis and/or cervical adenitis (PFAPA) was first described in 1987 by Marshall et al. Fever periodicity is a hallmark of the diagnosis, and there is a noted absence of upper respiratory tract (URTI) symptoms and sick contacts. Diagnosing PFAPA can be challenging for clinicians. The most common treatment is corticosteroids, given at the first sign of fever. A single dose of prednisone will abort the febrile episode; this is unique to PFAPA and essentially diagnostic.1 2 Tonsillectomy has also been reported to be curative.2

On 22 March 2020, New York State issued an executive ‘stay-at-home’ order due to the COVID-19 pandemic. This facilitated the diagnosis of PFAPA in our patient population. Travel and exposure to sick contacts, especially in day care, were markedly decreased, but a group of patients were still having periodic fevers. Furthermore, household members were not …

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  • Contributors Conception and design of the study/review was performed by TF, MA and LRK. Data generation was performed by TF and MA. Analysis and interpretation of the data was performed by TF, AN, MA and LRK. Preparation or critical revision of the manuscript was performed by TF, AN, MA and LRK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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