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.

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.

Although the most common causes of childhood chronic constipation are functional, a minority have an organic cause.We report an 11-year-old girl who was diagnosed as chronic constipation, but actually suffered from duodenal stenosis caused by Helicobacter pylori. An enhanced computed tomography was useful for investigation. Duodenal stenosis should be listed as a differential diagnosis for childhood chronic constipation.

Asymptomatic bacteriuria is occasionally found in healthy children. However, the fact that spina bifida occulta can be hidden in asymptomatic bacteriuria is not well known. We report an 8-year-old girl with asymptomatic bacteriuria. Spina bifida occulta was revealed by radiological examinations. Simple daily behavior, consisting of keeping the genitals clean, rehydrating regularly and not prolonging urination, was useful for removing asymptomatic bacteriuria in spina bifida occulta.