OPIS PRZYPADKU
Zespół PFAPA rozpoznany w wieku dorosłym- wyzwanie diagnostyczne i terapeutyczne- opis przypadku i przegląd literatury
Więcej
Ukryj
1
Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
2
Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland
Data nadesłania: 08-07-2019
Data ostatniej rewizji: 06-08-2019
Data akceptacji: 25-09-2019
Data publikacji online: 31-10-2019
Data publikacji: 19-11-2019
Reumatologia 2019;57(5):292-296
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is the most common cause of periodic fever in childhood. Reports of adult patients are sparse. In adults the clinical picture is more heterogeneous than in children, so PFAPA can be a real diagnostic challenge. Data regarding treatment efficacy and disease outcome are available mainly for children, whereas for adult patients they are limited and conflicting. Our aim is to increase the awareness about PFAPA among clinical practitioners. We present a case of PFAPA beginning in childhood and without resolution of symptoms in maturity. In our case the diagnostic delay was 15 years. We treated the patient with a prophylactic dose of colchicine. Colchicine helped to control flares and significantly improved the patient’s quality of life. Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis in adults is a rare disease, but it should be included in the differential diagnosis of fever of unknown origin in adults.
REFERENCJE (33)
1.
Hernández-Rodriguez J, Ruiz-Ortiz E, Tomé A, et al. Clinical and genetic characterization of the autoinflammatory diseases diagnosed in an adult reference center. Autoimmun Rev 2016; 15: 9-15.
2.
Cantarini L, Rigante D. Adult-onset autoinflammatory disorders: a still debated entity? Clin Exp Rheumatol 2015; 33: 137-140.
3.
Marques DP, Rocha S, Manso M, Domingos R. Periodic Fever with Pharyngitis, Aphthous Stomatitis and Cervical Adenitis Syndrome: A rare cause of fever in adults. Eur J Case Rep Intern Med 2019; 6: 001041.
4.
Alam F, Hammoudeh M. An underlooked cause of periodic fever (PFAPA) in an adult patient with no response to tonsillectomy. Case Rep Rheumatol 2018; 2018: 6580835.
5.
Marshall GS, Edwards KM, Butler J, Lawton AR. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr 1987; 110: 43-46.
6.
Thomas KT, Feder Jr HM, Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr 1999; 135: 15-21.
7.
Tasher D, Somekh E, Dalal I. PFAPA syndrome: new clinical aspects disclosed. Arch Dis Child 2006; 91: 981-986.
8.
Padeh S, Brezniak N, Zemer D, et al. Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome: clinical characteristics and outcome. J Pediatr 1999; 135: 98-101.
9.
Cattalini M, Soliani M, Rigante D, et al. Basic characteristic of adults with periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome in comparison with typical pediatric.
10.
expression of disease. Mediators Inflamm 2015; 2015: 570418.
11.
Padeh S, Stoffman N, Berkun Y. Periodic fever accompanied by aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA syndrome) in adults. Isr Med Assoc J 2008; 10: 358-360.
12.
Kutsuna S, Ohmagari N, Tanizaki R, et al. The first case of adult-onset PFAPA syndrome in Japan. Modern Rheumatol 2016; 26: 286-287.
13.
Rigante D, Vitale A, Natale MF, et al. A comprehensive comparison between pediatric and adult patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenopathy.
14.
(PFAPA) syndrome. Clin Rheumatol 2017; 36: 463-468.
15.
Vitale A, Orlando I, Lopaco G, et al. Demographic, clinical and therapeutic findings in a monocentric cohort of adult patients with suspected PFAPA syndrome. Clin Exp Rheumatol 2016; 34 (6 Suppl 102): 77-81.
16.
Cantarini L, Vitale A, Sicignano LL, et al. Diagnostic Criteria for Adult-Onset Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) Syndrome. Front Immunol 2017; 8: 1018.
17.
Gattorno M, Hofer M, Federici S, et al. Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis 2019; 78: 1025-1032.
18.
Cazeneuve C, Geneviève D, Amselem S, et al. MEFV gene analysis in PFAPA. J Pediatr 2003; 143: 140-141.
19.
Taniuchi S, Nishikomori R, Iharada A, et al. MEFV Variants in Patients with PFAPA Syndrome in Japan. Open Rheumatology J 2013; 7: 22-25.
20.
Cantarini L, Rigante D, Merlini G, et al. The expanding spectrum of low-penetrance TNFRSF1A gene variants in adults presenting with recurrent inflammatory attacks: clinical manifestations and long-term follow-up. Semin Arthritis Rheum 2014; 43: 818-823.
21.
Kraszewska-Głomba B, Matkowska-Kocjan A, Szenborn L. The Pathogenesis of Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome: A Review of Current.
22.
Research. Mediators Inflamm 2015; 2015: 563876.
23.
Cazzato M, Neri R, Possemato N, et al. A case of adult periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome associated with endocapillary proliferative glomerulonephritis. Clin Rheumatol 2013; 32 (Suppl 1): S33-36.
24.
Sugimoto K, Fujita S, Miyazawa T, et al. Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome and IgA nephropathy. Pediatr Nephrol 2013; 28: 151-154.
25.
Gaggiano C, Rigante D, Sota J, et al. Treatment options for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome in children and adults: a narrative review. Clin Rheumatol 2019; 38: 11-17.
26.
Wekell P, Karlsson A, Berg S, Fasth A. Review of autoinflammatory diseases, with a special focus on periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome. Acta Paediatr 2016; 105: 1140-1151.
27.
Tasher D, Stein M, Dalal I, Somekh E. Colchicine prophylaxis for frequent periodic fever, aphthous stomatitis, pharyngitis and adenitis episodes. Acta Paediatr 2008; 97: 1090-1092.
28.
Butbul Aviel Y, Tatour S, Gershoni Baruch R, Brik R. Colchicine as therapeutic option in periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome. Semin Arthritis Rheum 2016; 45: 471-474.
29.
Gunes M, Cekic S, Kilic SS. Is colchicine more effective to prevent PFAPA episodes in MEFV variants? Pediatr Int 2017; 59: 655-660.
30.
Dusser P, Hentgen V, Neven B, Koné-Paut I. Is colchicine an effective treatment in periodic fever, aphtous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome? Joint Bone Spine 2016; 86: 406-411.
31.
Burton MJ, Pollard AJ, Ramsden JD, et al. Tonsillectomy for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA). Cochrane Database Syst Rev 2014; 9: CD008669.
32.
Cantarini L, Vitale M, Galeazzi M, Frediani B. A case of resistant adult-onset periodic fever, aphtous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome responsive to anakinra. Clin Exp Rhumatol 2012; 30: 593.
33.
Lopalco G, Rigante D, Vitale A, et al. Canakinumab efficacy in refractory adult-onset PFAPA syndrome. Int J Rheum Dis 2015; 20: 1050-1051.
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