Clinical Cases

A Case of Recurring Fever

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Dr. Hara Varsakeli presents a case of PFAPA Syndrome.

The first consultation took place on March 2012.

A 2-year-old male visited the homeopath for a recurring fever ever since the age of 6 months.

Fever up to 39,5º C. Red pharynx (1), tonsils (2) and difficulty in swallowing (2). Each episode lasts for 1-3 days. It comes periodically every 18-20 days.

A few days before the manifestation of these symptoms, he wakes up in the night in fright (2) and also talks during sleep (1). In between the child is perfectly fine.

Later, when the boy was 12 months old, cervical lymphadenitis was also added to the clinical picture of the child. Then he was hospitalized in University Pediatric clinic where PFAPA syndrome was diagnosed. Cortisone was administered to which the patient responded immediately.

PFAPA Syndrome -Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis

PFAPA syndrome or Marshall syndrome is an auto-inflammatory disease of unknown etiology which is characterized by periodic fever combined with apthous stomatitis, pharyngitis, tonsillitis and cervical lymphadenitis. It is a relatively rare disease which develops in children under 5 years of age and it is followed by spontaneous remission after a few years. Children with PFAPA syndrome are usually healthy. The diagnosis is determined by exclusion and the treatment is based on antipyretics and corticosteroids.

The diagnostic criteria of PFAPA syndrome:

  1. Recurring fever.
  2. Symptoms in the absence of upper respiratory tract infection with at least one of the following clinical signs:
    • Apthous stomatitis
    • Pharyngitis
    • Cervical lymphadenitis
  3. Completely asymptomatic intervals and normal development between episodes
  4. Remission of symptoms after the administration of cortisone
  5. Exclusion of cyclic neutropenia (Homeopathy Treatment for Neutropenia )

There are no diagnostic laboratory findings or etiological treatment. The treatment is based on the administration of cortisone.

Tonsillectomy, even though it is a questionable method of treatment, showed that it can provide complete remission in up to 50% of the cases, most probably due the participation of some antigens in the parenchyma of the tonsils which trigger these episodes through an immunological process. Nevertheless PFAPA is not an absolute indication for tonsillectomy. The PFAPA syndrome can have a significant impact on quality of life and mentality, since it has a chronic course and can lead to many unnecessary tests and hospitalizations, as well as to a restriction of normal childhood.

Homeopathic history

He is the only child of the family, aged 3.

The conception was normal.

Cesarean section.

The weight of the child when born was 3150 grams.

The child was breastfed till the age of 4 months.

Cannot tolerate warm (3), perspires (1) during sleep on back and head (2).


Always has a pillow between his thighs.

Does not talk in sleep, does not grind teeth, salivation (1).


Sees nightmares (1) and wakes up in fright (2).

Gastrointestinal tract

Without problems.

Desires chocolate (3), ice cream (3), ripe fruits (2), cheese (2), eggs (2), pasta (2), chicken (2), warm milk (3).

Thirst (2) for cold water.

Fears: dogs (2), noises (2), rain (2), dark (2), injections (3), water on face- head (2).

Mental/ emotional picture:

His parents say he is sociable (2), friendly (2), never a leader, always a follower. He always wants someone by his side.

Not aggressive.

Easily offended, bows his head.

His parents are very worried.

They are taking very good care of the child so he won’t get sick.

The child stays in the house all the time, never goes outdoors.

He is not participating in parties with other children, doesn’t go to the park, to nature.

Lives isolated, according to the parents, in order to be protected.

Observation: The child is sweet, smart and very obedient.


The pathology is not severe, but there are factors that affect the child, since the disease cannot be cured.

  1. The drugs that are administered during the hospitalizations.
  2. The restriction of the life of the child.
  3. The concern and the fear of the parents which is perceived by the child.
  4. The danger of tonsillectomy, as the tonsils are extremely important for the defense mechanism of the organism.

Normal childhood is essential, since it may predict the whole life of an individual, based on the first impressions that are registered.  The homeopathic treatment is a great therapeutic method because it can cure children in the very first phase of their lives. It is especially effective in organisms that have not used chemical drugs and in which no chronic diseases are established. According to classical Homeopathy the selection of the remedy is based on the totality of the symptoms.  In this case,  during the search for the simillimum it is found that there are symptoms of 3 remedies; Phosphorus, Stramonium and Calcarea Carbonica.

Which is the remedy we must start with?

We choose Stramonium because:

  • The characteristic fears of Stramonium are present.
  • A few days before getting sick, the child has nightmares and wakes up in fright.
  • It’s a quiet child and frightened.

The following symptoms are also included: fever, redness of the throat, sweating (general and at night), salivation. These symptoms are covered by the other 2 remedies, as well.

One dose of Stramonium 1M was prescribed.

First follow up: 40 day after. On the first day the remedy was administered, after few hours the child developed fever 38.5º C and another pyretic wave was manifested the day after. Since then, the child has not presented any other symptom. The sleep is better; the child is calmer during sleep.The appetite is good. He may be more aggressive.

Second follow up: 3 months later

The child is very well, did not develop fever again.

The parents have almost forgotten that the child was sick.

The child started going to the day nursery.

His appetite is good.

He does not desire eggs so much like he did in the past.

Sleep is very good.

His dreams are good.

He is not afraid of dogs but still has some fears; thunderstorms (1), ghosts (2).

He has great thirst for cold water.

Since the child is very well concerning his previous problems and in general, we wait.

The follow up 3 – 4 months later:

The child is pretty well.

He still craves cold water (3).

Desires ice cream (3), chocolate (3).

Is still afraid of the dark (2), thunderstorms (2), fear for high places appeared for the first time (1).

He started having cold feet.

The parents notice his is sympathetic (2).

The second remedy is clear now. Its picture is fully developed and can be prescribed.  Phosphorus 200C, one dose, was administered.

Fourth follow up – One year later:

The child was completely well during all this period until 2 months ago when a cough started (1) which lasted for a long time and reached its peak the last 2 days, with exhaustion (2), weakness (1), fever 39,6º C, sour smell (2) from the mouth.

Cold feet (2) and clammy (1).

Wears socks but puts them off during the night.

Perspiration in the neck (2).

Thirst (2).

Desires sweets (3), eggs (3), milk (3).

The sleep is good.

One dose of Calcarea carbonica was prescribed.


In the beginning of 2016, the parents were contacted and confirmed that the child is doing very well. His mood is good and he is cooperative, hardworking and is developing normally. His appetite is good. His sleep is good. It seems that his level of health is high.

Our treatment was based on the laws and principles of classical Homeopathy.

About the author

Hara Varsakeli

Dr. Hara Varsakeli was born in Thessaloniki. She earned a medical degree from the School of Medicine at Aristotle University of Thessaloniki and did her specialty training in Pulmonology at the Department of Pulmonary Medicine. She worked at the Pulmonary Clinic for the next 10 years. Upon the establishment of the National Health Service, she joined the Hippocrateio General Hospital of Thessaloniki as a Consultant Pulmonologist, retiring 10 years later as a Deputy Director. She has been studying classical homeopathy since 1980 and in 1990 she was elected to the trade union of homeopathic practitioners for two four-year terms—the first as Vice President and the second as President. Dr. Varsakeli subsequently attended classes at IAHC (International Academy of Classical Homeopathy). Since 2003 she has maintained a private practice exclusively applying classical homeopathy as a therapeutic method. In 2000, the IAHC asked her to train doctors, dentists, veterinarians and pharmacists in Northern Greece, following the full standard two-year program. Many scientists have already graduated from the program having added classical homeopathy in their therapeutic arsenal. This last year the postgraduate program for difficult cases diagnosed and treated by Prof. George Vithoulkas is being offered for the first time. Dr. Varsakeli has the pleasure of presenting it.


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