The role of inflammatory mediators in the pathogenesis of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome

Mol Biol Rep. 2022 Aug;49(8):8061-8069. doi: 10.1007/s11033-022-07352-x. Epub 2022 Mar 23.


Introduction: As a recurrent disease, periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by episodes of febrile attacks and is often prominent in children under five years of age. However, the etiology of this condition has not been fully understood yet.

Materials and methods: The search in the extensive literature of peer-reviewed articles published from the inception to December 2021 was conducted to identify the relevant studies, using the electronic databases of MEDLINE/PubMed, Embase, Scopus, the Cochrane Library, and the Web of Science.

Results: The analysis of complex relationships indicates that inflammatory factors, such as various cytokines and acute-phase proteins (APPs), play leading roles in the pathogenesis of this disease. Accordingly, this article summarizes the current state of knowledge to explain the mechanisms involved in inflammatory responses among patients with PFAPA syndrome and investigate its role in the pathogenesis of this disease. Moreover, the possibilities for further implementation of new therapeutic strategies are pointed out.

Conclusion: It is concluded that some pathophysiological processes are associated with immune dysregulation, which itself may be secondary to environmental factors, genetic background, and underlying diseases, including latent infections that multiply inflammatory mediators. elevated inflammatory markers similarly play a significant part in the clinical outcomes of this condition, whose pyrogenic nature is the reason for the development of episodes of febrile attacks in the population of patients suffering from PFAPA syndrome.

Keywords: Acute phase protein; Cytokine; Fever; Inflammation; PFAPA syndrome.

Publication types

  • Review

MeSH terms

  • Amyloidosis*
  • Child
  • Child, Preschool
  • Fever / complications
  • Fever / therapy
  • Humans
  • Inflammation Mediators
  • Lymphadenitis* / complications
  • Lymphadenitis* / therapy
  • Pharyngitis* / complications
  • Pharyngitis* / therapy
  • Stomatitis, Aphthous* / complications
  • Stomatitis, Aphthous* / therapy
  • Syndrome


  • Inflammation Mediators