Pediatric Resident Seeks Hot Button that Triggers Recurrent Fevers

Hoffman Broderick

February 22, 2010, San Diego, CA - Unlike most kids who contract the flu during flu season, four-year old André* ‘caught the flu’ around the same time every month. His mother, Maria, could almost predict when André would get sick. He had been to the doctor dozens of times, always with the same problems: sore throat and fever, but strep cultures were always negative. Despite multiple rounds of antibiotics, nothing seemed to help. Hoping to find a cause and a cure for André, Maria brought him to our UC San Diego’s renowned Allergy & Immunology Clinic.

Fortunately for André, he was seen by then 2nd-year Pediatrics Resident, Dr. Lori Broderick who was intrigued by the uncanny timing of André’s fever episodes. The fevers seemed to have a pattern of occurring periodically every month for the past two years. She presented the patient to Dr. Hal Hoffman, a UCSD physician-scientist in the Division of Pediatric Allergy/Immunology and recurrent fever expert, who made the diagnosis of PFAPA: Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis – a form of recurrent fever that is periodic, but not clearly inherited.

Often mistaken for an infection, immune deficiency or autoimmune disease, PFAPA is actually an auto inflammatory disease. Researchers believe that children who suffer from PFAPA may have a genetic predisposition to recurrent fever that is latent in their immune system. It appears that PFAPA kids have a dysregulated immune system that reacts to ‘normal’ microbes that healthy children are able to ignore. While the mechanism is unclear, researchers have found that removing the tonsils of children with PFAPA has proven to be an effective cure. Curious as to what could be the link between André’s tonsils and his symptoms, Dr. Broderick set out to find the answer.

Inspired by her translational research project idea, Dr. Broderick created a research proposal with Dr. Hoffman to secure funding. Dr. Broderick received initial funding from the UCSD Department of Pediatrics Resident Research Program, and was recently awarded a research grant from the American Academy of Pediatrics. In a generous collaboration with Dr. Seth Pransky and other Rady Children’s Hospital ENT physicians, Dr. Broderick has been able to pick up the tonsils as soon as they are removed from kids who were diagnosed with PFAPA, and take them back to the lab for analysis. Over the past year, Dr. Broderick has actively collected and analyzed data from over 80 children and tonsils from over 25 children. Driven to find a cause – and a possible cure – Broderick plans to stay in Dr. Hoffman’s lab to continue her research as an Allergy/Immunology fellow after completing her residency program. “This is an excellent example of bedside to bench research that UCSD pediatricians are well positioned to undertake”, says Hoffman.

The Pediatrics Division of Allergy and Immunology provides comprehensive clinical services for children with allergic and immunologic diseases, and Kawasaki disease in outpatient and inpatient settings at a variety of venues throughout San Diego County. The Division also maintains an internationally recognized research program in the areas of translational and clinical research in the genesis and treatment of allergic diseases, auto inflammatory disorders, genetics of rare inherited immune diseases, and Kawasaki disease.

If you are interested in pursuing residency research or fellowship opportunities in our Department of Pediatrics, you can review our research specialties at: Divisions of Pediatrics

To contact our clinic, please call: 858-966-5961

WRITTEN BY: Shivani Singh, Sr. Writer, Pediatrics, UC San Diego s1singh@ucsd.edu

SCIENTIFIC CONTACT: Dr. Hal Hoffmann, Division of Pediatric Allergy and Immunology, UC San Diego hahoffman@ucsd.edu

*Not actual names of patients.