Differential Diagnosis for a 4-year-old with Reoccurring Fevers every Week
Single most likely diagnosis
- Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome: This condition is characterized by recurring fevers accompanied by other symptoms such as sore throat, mouth ulcers, and swollen lymph nodes, typically occurring every 3-8 weeks. It's a common cause of periodic fever in children.
Other Likely diagnoses
- Recurrent urinary tract infections (UTIs): Young children, especially girls, are prone to UTIs, which can cause recurring fevers. The frequency of fevers could be related to the recurrence of infections.
- Recurrent upper respiratory tract infections: Children are often exposed to various pathogens, leading to frequent upper respiratory infections, which can manifest as recurring fevers.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause recurring fevers, among other symptoms such as abdominal pain and changes in bowel habits.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Malignancies (e.g., leukemia, lymphoma): Although rare, malignancies can present with recurring fevers and must be considered to ensure timely diagnosis and treatment.
- Tuberculosis (TB): TB can cause recurring fevers, especially in children exposed to someone with active TB or in areas with high TB prevalence.
- Endocarditis: This infection of the heart valves can cause recurring fevers and is a medical emergency.
Rare diagnoses
- Hyper-IgD syndrome (HIDS): A rare genetic disorder characterized by recurring fevers, often accompanied by other symptoms like abdominal pain, rash, and joint pain.
- Familial Mediterranean Fever (FMF): An inherited condition that causes recurring fevers, often accompanied by abdominal or chest pain, and is more common in certain ethnic groups.
- Autoinflammatory disorders (e.g., Cryopyrin-associated periodic syndrome): These are rare genetic conditions that cause recurring fevers and inflammation, often with other systemic symptoms.