title: Marshall syndrome in a young child, a reality: Case report.
abstract: BACKGROUND
  Recurrent fever syndrome, known as the Marshall syndrome (MS), is a clinical entity that includes several clinical features, such as: fever (39-40°C) that occurs repeatedly at variable intervals (3-8 weeks) and in episodes of 3 to 6 days, cervical adenopathy, pharyngitis, and aphthous stomatitis. The diagnosis of MS is one of exclusions; laboratory data is nonspecific and no abnormalities correlated with MS have been detected thus far.
  
  
  METHODS
  The authors report the case of a 2-year-old girl admitted to a tertiary pediatric center for repeated episodes of fever with aphthous stomatitis and laterocervical adenopathy.
  
  
  RESULTS
  The child's case history raised the suspicion of MS, which was subsequently confirmed by exclusion of all the other differential diagnoses (recurrent tonsillitis, juvenile idiopathic arthritis, Behçet's disease, cyclic neutropenia, hyperglobulinemia D syndrome). After the 3 febrile episodes, bilateral tonsillectomy was performed based on the parents' consent, with favorable immediate and remote postoperative clinical outcomes. The diagnosis of MS is one based on exclusion, as laboratory data is nonspecific. We took into consideration other causes of recurrent fever (recurrent tonsillitis, infectious diseases, juvenile idiopathic arthritis, Behçet's disease, cyclic neutropenia, Familial Mediterranean fever syndrome, hyperglobulinemia D syndrome). In our case, MS criteria were met through clinical examination and the child's outcome. Subsequently, laboratory data helped us establish the MS diagnosis.
  
  
  CONCLUSIONS
  Pediatricians should consider the MS diagnosis in the context of recurrent fever episodes associated with at least one of the following symptoms: pharyngitis, cervical adenopathy or aphthous stomatitis. Despite the indication for tonsillectomy in young children being controversial, in this case the surgery led to the total remission of the disease.
authors.affiliation: "Sfanta Maria" Clinical Emergency Hospital for Children "Grigore T. Popa" University of Medicine and Pharmacy, Iasi Endocrinology Department of Clinical County Emergency Hospital, Cluj-Napoca ENT Department of Arcadia Hospital, Iasi, Romania.
authors.forename: Laura Mihaela
authors.initials: LM
authors.lastname: Trandafir
authors.forename: Madalina Ionela
authors.initials: MI
authors.lastname: Chiriac
authors.forename: Smaranda
authors.initials: S
authors.lastname: Diaconescu
authors.forename: Ileana
authors.initials: I
authors.lastname: Ioniuc
authors.forename: Ingrith
authors.initials: I
authors.lastname: Miron
authors.forename: Daniel
authors.initials: D
authors.lastname: Rusu
mesh_terms: D002386:Cataract / Q000150:complications / Q000175:diagnosis*; D002675:Child, Preschool; D024161:Collagen Type XI / Q000172:deficiency*; D019465:Craniofacial Abnormalities / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D010009:Osteochondrodysplasias / Q000150:complications / Q000175:diagnosis*
chemical_list: D024161:Collagen Type XI