Differentiating PFAPA syndrome from monogenic periodic fevers.
OBJECTIVE
To analyze whether there were clinical differences between genetically positive and negative patients fulfilling periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome criteria and to test the accuracy of the Gaslini diagnostic score for identifying patients with PFAPA syndrome with higher probabilities of carrying relevant mutations in genes associated with periodic fevers.


METHODS
Complete clinical and genetic information was available for 393 children with periodic fever; 82 had positive genetic test results, 75 had incomplete genetic test results, and 236 had negative results for MVK, TNFRSF1A, and MEFV mutations. Current diagnostic criteria for PFAPA syndrome were applied.


RESULTS
Of 393 children, 210 satisfied PFAPA syndrome criteria; 43 carried diagnostic mutations (mevalonate kinase deficiency: n = 33; tumor necrosis factor receptor-associated periodic syndrome: n = 3; familial Mediterranean fever: n = 7), 37 displayed low-penetrance mutations or incomplete genotypes, and 130 demonstrated negative genetic testing results. Genetically positive patients had higher frequencies of abdominal pain and diarrhea (P < .001), vomiting (P = .006), and cutaneous rash and arthralgia (P = .01). Genetically negative patients had a higher frequency of exudative pharyngitis (P = .010). Genetically undetermined patients showed the same pattern of symptom frequency as genetically negative patients. The Gaslini diagnostic score was able to identify 91% of genetically positive patients correctly, with a global accuracy of 66%.


CONCLUSIONS
The Gaslini diagnostic score represents a useful tool to identify patients meeting PFAPA syndrome criteria and at low risk of carrying relevant mutations in genes associated with periodic fevers.
Gattorno
Marco
M
UO Pediatria II, G. Gaslini Institute, Largo G. Gaslini 5, 16146, Genova, Italy. marcogattorno@ospedale-gaslini.ge.it
Caorsi
Roberta
R
Meini
Antonella
A
Cattalini
Marco
M
Federici
Silvia
S
Zulian
Francesco
F
Cortis
Elisabetta
E
Calcagno
Giuseppina
G
Tommasini
Alberto
A
Consolini
Rita
R
Simonini
Gabriele
G
Pelagatti
Maria Antonietta
MA
Baldi
Maurizia
M
Ceccherini
Isabella
I
Plebani
Alessandro
A
Frenkel
Joost
J
Sormani
Maria Pia
MP
Martini
Alberto
A
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D010505:Familial Mediterranean Fever / Q000175:diagnosis / Q000235:genetics*; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000235:genetics; D005786:Gene Expression Regulation; D020022:Genetic Predisposition to Disease; D006801:Humans; D008199:Lymphadenitis / Q000175:diagnosis / Q000235:genetics*; D008297:Male; D009154:Mutation; D010612:Pharyngitis / Q000175:diagnosis / Q000235:genetics*; D017853:Phosphotransferases (Alcohol Group Acceptor) / Q000235:genetics; D018124:Receptors, Tumor Necrosis Factor / Q000235:genetics; D013281:Stomatitis, Aphthous / Q000175:diagnosis / Q000235:genetics*; D013577:Syndrome
D018124:Receptors, Tumor Necrosis Factor; D017853:Phosphotransferases (Alcohol Group Acceptor); C021796:mevalonate kinase