Periodic Fever

A 4-year-old adopted boy of mixed African American and Caucasian race was referred for consultation because of recurring fever. Before the age of 1 year, he had begun to have monthly febrile illnesses without diagnoses. By 2 years of age, febrile episodes were periodic, occurring approximately once in a month and had a characteristic pattern of sudden rise in temperature to 38.6–39°C, vomiting on the first day, seeming stiffness, poor appetite, and swollen neck glands. Episodes lasted 3 days. By 3 years of age and continuing to the time of referral, episodes had the same character and periodicity. However, an additional feature was sudden mood change during episodes with crankiness and temper tantrums. He had been evaluated during several episodes by his pediatrician who found no organ-specific findings. Fever was modestly responsive to acetaminophen and ibuprofen.