Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by periodic febrile attacks recurring regularly every 2 to 8 weeks. Although tonsillectomy is offered as an effective treatment, the effectiveness of cimetidine treatment is still controversial. In this article, we describe two cases. A 1-year-old girl with PFAPA syndrome received cimetidine treatment and febrile attacks were reduced. Tonsillectomy was successfully performed on a 6-year-old boy with PFAPA syndrome. We suggest that the use of cimetidine may reduce febrile attacks of PFAPA syndrome until an age that is safer for tonsillectomy.

Umbilical granuloma is a common umbilical problem in infants. Although various modalities are available for the treatment of umbilical granulomas, the best method remains controversial. A 7-week-old infant presented with umbilical granuloma followed by omphalitis. We treated the omphalitis first to prevent local inflammation. On the following day, the umbilical granuloma was successfully cut off with a nylon suture thread. No residue of the granuloma was left behind and no signs of local inflammation appeared. Umbilical granuloma can be successfully removed with a nylon suture thread. Treatment for omphalitis before granuloma removal may be useful to prevent local inflammation.

Bloody diarrhoea in children is indicative of serious diseases. Although bloody diarrhoea following bacterial colitis is well known, reddish diarrhoea caused by excessive ingestion of watermelon is unknown. A two year old girl who excessively ingested watermelon presented with repeated reddish diarrhoea. A kit for fecal occult blood testing revealed that the reddish diarrhoea did not contain blood. Reddish diarrhoea caused by excessive ingestion of watermelon can be a mimicker of bacterial colitis. The kit for fecal occult blood testing was useful for differential diagnosis. We should be aware that this pitfall can be hidden in daily nutrition.

Although the etiology of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome remain unclear, various treatments have been reported. We here describe two thought-provoking cases. Our experience suggests that tonsillectomy is effective against PFAPA syndrome, and can safely be performed in patients three years and older. We recommend that tonsillectomy be considered as early as possible in patients with PFAPA syndrome.

Vesicoureteral reflux is a common condition in infants with urinary tract infection. Although antibiotic prophylaxis to prevent recurrent urinary tract infection is widely performed, its effectiveness remains controversial. Herein we report a seven- month-old boy with vesicoureteral reflux. Antibiotic prophylaxis with amoxicillin caused microbial resistance accompanied by recurrent urinary tract infection. Subsequent antibiotic prophylaxis with sulfamethoxazole-trimethoprim was effective until spontaneous remission of vesicoureteral reflux occurred. Sulfamethoxazole-trimethoprim, but not amoxicillin, should be considered as an agent for antibiotic prophylaxis in infants with vesicoureteral reflux.