Subjective
Date of visit
Reason for visit (initial presentation, follow-up for PFAPA syndrome)
History of present illness:
Frequency and duration of periodic fever episodes (classical triad: fever, aphthous stomatitis, cervical adenitis)
Characteristics of fever (temperature range, duration of each episode)
Presence of aphthous ulcers in the mouth (mouth sores)
Swollen lymph nodes in the neck (cervical adenopathy)
Other associated symptoms during episodes (e.g., malaise, headache, abdominal pain)
Interval symptoms between episodes (well-being)
Past medical history (relevant illnesses, surgeries)
Medications (current medications)
Allergies
Objective
Vital signs (temperature during visit – note if episodic fever is present)
Physical exam:
General (signs of systemic illness during fever episode)
Oropharyngeal exam (looking for aphthous ulcers)
Neck examination (palpation for enlarged lymph nodes)
Assessment
PFAPA syndrome (suspected based on clinical presentation of periodic fever, aphthous stomatitis, cervical adenitis)
Consider alternative diagnoses (other periodic fever syndromes, recurrent infections)
Plan
Diagnostic workup (may be limited if presentation is classic):
Complete blood count (CBC)
Inflammatory markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR])
Other tests may be considered to rule out differentials (e.g., Epstein-Barr virus [EBV] serology)
Management:
Supportive care during fever episodes (hydration, antipyretics like ibuprofen)
Corticosteroids (short courses) – may be helpful in reducing the severity and duration of episodes
Consideration of prophylactic medications (tonsillectomy – controversial, discuss with specialist)
Education
Explain the diagnosis of PFAPA syndrome and its episodic nature
Discuss treatment options and potential benefits and risks
Follow-up
Schedule for next appointment:
Monitor frequency and severity of fever episodes
Consider referral to a rheumatologist for further evaluation and management (especially if atypical presentation or lack of response to treatment)
Note: This template is a guide and may need to be modified based on the individual patient’s presentation, frequency of episodes, and response to treatment.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of PFAPA syndrome.