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Mysterious fevers of unknown origin: Could surgery be a cure?
Date:3/28/2008

A child spikes a high fever, sometimes as high as 104 or 105 degrees, and sometimes causing seizures. Shes rushed to the emergency room, the hospital runs test after test, specialists are brought in, but no explanation is found.

Many families though no one knows how many go through this cyclical nightmare. The fevers seem to come like clockwork, arent accompanied by any obvious symptoms and dont respond to antibiotics or fever reducers like Motrin or Tylenol. Instead, they vanish on their own after four to five days, only to return four to six weeks later.

A report in last months Archives of Otolaryngology and Head and Neck Surgery finds that tonsillectomy (with or without removal of the adenoids) is almost always curative. No one knows why the tonsils and adenoids show no evidence of unusual infection or other abnormality when pathologists study them. But desperate families are opting for surgery as a last-ditch measure and finding it to be life-changing.

The paper, describing 27 children treated at Childrens Hospital Boston from 2004 through 2006, offers the largest reported surgical experience to date with this syndrome, currently known as PFAFA (periodic fever, aphthous ulcers, pharyngitis and adenitis). Of the 27 children, 26 had complete fever resolution. Many had suffered cyclical fevers for years.

Why taking out tonsils and adenoids works is unclear, but it works in almost every single kid, says Childrens otolaryngologist Greg Licameli, MD, FACS, the papers first author. I tell parents, I dont know why this works, but it has a good chance of ridding your child of fevers.

Licameli has now seen 60 children with PFAFA, first described in the medical literature in 1987, and the findings continue to hold up. Given how many children hes seen in just five years, he thinks the condition isnt all that uncommon, though it is underrecognized and unknown to most pediatricians and otolaryngologists.

Licamelis
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Contact: Keri Stedman
keri.stedman@childrens.harvard.edu
617-919-3110
Children's Hospital Boston
Source:Eurekalert

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