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Introduction: PFAPA syndrome usually occurs in childhood and it´s characterized by Periodic Febrile episodes, associated with Aphthous stomatitis, Pharyngitis and cervical Adenopathies. Between episodes children are asymptomatic. The diagnosis is made by clinical features and by exclusion.

The authors pretend to alert that PFAPA, a underknown entity, is the one of the most common periodic fever syndromes.

Case report: A 3-years-old boy, with adequate growth and development for his age, presents since 19 months born, episodes of periodic fever, associated with recurrent pharyngitis/tonsillitis and cervical adenopathies. He was treated with multiple antibiotics with poor response and was asymptomatic between episodes.

The recurrent episodes and ineffective therapeutic generated anxiety to parents. In coincidence with a new febrile episode, oral corticosteroid therapy was started with drastic improvement in symptoms.

PFAPA syndrome was suspected so a paediatric appointment was requested, other causes of periodic fever syndromes were excluded and the diagnosis of PFAPA syndrome was made.

Conclusion: This report has a typical presentation of PFAPA, the onset was before the age of 5, with characteristic periodic symptoms, and healthy condition between episodes.

As expected in PFAPA, treatment with antipyretics and antibiotics is ineffective. The response to corticosteroids is excellent, reduces febrile episodes, supports the diagnosis, but doesn’t prevent new episodes.

More than a rare entity, PFAPA syndrome is underdiagnosed. PFAPA diagnosis is crucial because allows to reduce anxiety and improve quality of life of children and family members, as well reduce health costs and avoid unnecessary antibiotic treatments.

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We present a case of meningitis in a 4 year-old male child, caucasian, previously healthy, of bacterial etiology - Bacilus cereus - an atypic agent, ubiquous in nature and with Central Nervous involvement only described in immunocompromised patients. intravenous drugs users or submited to neurosurgery. Typical disease corresponds to a food intoxication, either emetic or diarrheal.

The child enters the unit droopy, sleepy, feverish, with frontal headache, and vomiting since that morning. The day before he would be as usual, in good mood, ate normally. Unremarkable for other gastrointestinal or urological symptoms, no phono or photophobia, no Known exposure, updated vaccine program, height-weight development in the lower normal range (P3-P15). Further exploration reveals acute tonsillitis diagnosed 10 days before, medicated with amoxicillin, which was carried out for 2 days, until apyrexia, and suspended without a medical advice.

At physical examination, the child remains conscient and reactive, albeit drousy, with 38.8ºC, sore-throat and Kernig and Brudzinski positive, highlighting a possible meningeal inflamation, and immediately being transfered for hospital emergency care where blood, urine and cerebrospinal fluid was drawed for analysis and culture and empyrical treatment was started with Ceftriaxone 100mg/Kg/day and Acyclovir 15mg/Kg/day.

Results showed growth of Bacilus cereus in the cerebrospinal fluid, and negative for other causal agents, viral or bacterial.

Symptoms started to evanesce after antibiotherapy, with complete resolution at day 3 of treatment, and no apparent long-term complications.

This case illustrates the importance of being aware fore neurological signs of infection, and mantaining a high level of suspicion when a child comes to office, even though meningitis are not so often, nowadays.