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Autoimmune & autoinflammatory

PFAPA in adults

PFAPA - periodic fever with aphthous ulcers, pharyngitis and cervical adenitis - is best known in pre-school children, but adult-onset and adult-persistent cases are increasingly recognised and treatable.

Key points

The essentials at a glance.

What to look out for, which tests matter, who treats it, and what usually happens next.

  • Signature rhythm: fever episodes lasting 3-6 days recurring with clockwork regularity every 3-8 weeks

  • Attacks combine fever with mouth ulcers, sore throat and tender neck glands; between attacks health is completely normal

  • Adults show the same pattern but less regular periodicity - the clockwork can be looser

  • A single dose of prednisolone at attack onset typically aborts the episode - itself a diagnostic clue

  • Diagnosis is clinical after excluding infection, cyclic neutropenia and the genetic fever syndromes

Understanding it

About PFAPA in adults.

Parents of PFAPA children famously book the next fever in the calendar - the periodicity is that precise - and while most childhood cases resolve by adolescence, follow-up studies show a subset persisting into adulthood, alongside genuinely adult-onset cases that clinicians rarely think to name. The adult attack looks like recurrent tonsillitis with mouth ulcers and fevers that swab-negative throats and unhelpful antibiotics never explain, repeating every month or two for years.

The work-up excludes the impostors: throat cultures during attacks, full blood counts timed to catch cyclic neutropenia, and genetic fever panel testing where features overlap. Management then offers real choices - a steroid dose at onset that reliably truncates attacks, colchicine to stretch the interval between them, and tonsillectomy, which carries a strong evidence base in children and a more mixed but sometimes decisive record in adults. In many parts of the UK, a routine NHS referral to the relevant specialist clinic currently means waiting many months - sometimes more than a year for the rarest conditions - whereas an initial appointment with a private consultant is typically available within around two weeks, with investigations arranged soon after.

Frequently asked

Common questions about PFAPA in adults.

Quick, plain-English answers to what people ask us most.

  • What is PFAPA in adults?

    PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, and Adenitis) is a recurrent fever syndrome most commonly diagnosed in children, but it can occasionally persist into or first appear in adulthood.

  • What causes PFAPA?

    The exact cause is unclear, but it's thought to involve dysregulation of the innate immune system, triggering recurring episodes of fever and inflammation without an infectious cause being identified.

  • What are the symptoms?

    Recurrent episodes of fever lasting three to six days, along with mouth ulcers, sore throat, and swollen neck glands, occurring in a fairly regular cycle every few weeks, are the hallmark features.

  • Is PFAPA in adults serious?

    It's generally not dangerous, and between episodes people feel entirely well, but the recurring symptoms can significantly disrupt daily life and work, making accurate diagnosis and management valuable.

  • Can PFAPA be treated?

    Yes, a single dose of steroid medication at the start of an episode can shorten or abort it in many people, and colchicine is sometimes used to reduce how often episodes occur.

  • How is PFAPA diagnosed?

    Diagnosis is based on the characteristic pattern of recurrent episodes with the specific combination of symptoms, after ruling out other causes of recurrent fever through blood tests and, sometimes, genetic testing.

  • How long do PFAPA episodes typically last?

    Individual episodes usually last three to six days, recurring every three to eight weeks, with the person feeling completely well between episodes.

  • PFAPA vs recurrent tonsillitis — what's the difference?

    Recurrent tonsillitis is caused by repeated bacterial or viral throat infections and responds to antibiotics when bacterial, while PFAPA doesn't respond to antibiotics and instead follows a distinctive periodic pattern with additional features like mouth ulcers.

  • Does PFAPA in adults resolve on its own?

    In children, PFAPA often resolves spontaneously over time, but the pattern in adults is less well understood and can be more persistent, sometimes needing ongoing management.

  • When should I see a specialist, and how quickly can I be seen privately?

    See a specialist if you experience a recurring, unexplained pattern of fever with mouth ulcers and sore throat. Private specialist assessment can typically be arranged within about two weeks, much faster than the standard NHS pathway for this rare condition.