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Q: My child suspected of PFAPA developed a fever, rash, and leg pain after stopping steroids. Should we see a doctor before our appointment?

  • Myeongchan Kim
  • 3 days ago
  • 3 min read

Medically reviewed by Sang Hyun Ahn, MD

Content edited by Myeongchan Kim, MD


This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.



Question:

My child is currently suspected of having PFAPA syndrome. We were hospitalized briefly due to high inflammation markers and discharged the next day. After discharge, my child took steroids for 5 days. Then, a facial breakout appeared, so the steroid dosage was adjusted to twice a day for 3 more days. However, the facial breakout continued even during this time.


It has now been 3 days since we completely stopped the steroids. My child's face has a lot of bumpy rashes, and their eyes look swollen. Their body temperature is also fluctuating, reaching about 38°C in the evening, and I am worried a high fever might return. My child is also complaining of leg pain. Our next outpatient appointment is in a week. Should we do another blood test? Is it better to go in and see the doctor tomorrow instead of waiting?


Answer:

I understand how concerned you must be seeing your child develop a rash, swelling, and pain after stopping the steroids.


Current Situation Summary

Your child took steroids for a total of 8 days (5 days full dose + 3 days tapered) and has been off them for 3 days. They are now experiencing a bumpy facial rash, eye swelling, an evening fever of 38°C, and leg pain.


When to See a Doctor Immediately

If any of the following apply, do not wait for your scheduled appointment next week. Please contact your pediatrician tomorrow morning:

  • The fever rises to 39°C or higher, or does not respond well to fever-reducing medication.

  • The rash does not disappear when pressed (suspected non-blanching purpura) or spreads rapidly.

  • The leg pain makes it difficult for your child to walk, or the joints are swollen and hot.

  • There is decreased urine output (no urination for over 8 hours), refusal to drink fluids, or severe lethargy.

  • Your child experiences a stiff neck, severe headache, or repeated vomiting.


What to Do Tonight at Home

  • Monitor and record your child's body temperature, the extent of the rash, and the severity of the leg pain every 2-3 hours.

  • Provide water or electrolyte drinks frequently in small amounts to keep them hydrated.

  • Take photos of the rash so you can show the doctor exactly how it has changed over time.

  • Use a fever reducer (like acetaminophen every 4-6 hours) only if your child is uncomfortable.


PFAPA Relapse vs. Other Causes

Experiencing a fever, rash, and joint pain simultaneously 3 days after stopping steroids suggests that we must consider possibilities beyond a simple PFAPA relapse. This combination of symptoms could point to a drug reaction, a viral infection, or another systemic inflammatory condition (such as Kawasaki disease or a rheumatological issue). Because of this, a blood test (to check inflammation markers, platelets, liver function, etc.) and a physical evaluation of the rash and joints will likely be necessary tomorrow.


Questions to Ask Your Doctor During the Visit

  • "Since the rash, swelling, and joint pain appeared after stopping steroids, could this be a drug reaction or a relapse?"

  • "Do we need a blood test to recheck inflammation markers and platelets?"

  • "Is it possible that the leg pain is a sign of arthritis?"


Conclusion:

The combination of a returning fever, a spreading rash, and leg pain strongly indicates the need for an in-person clinical evaluation tomorrow. Please do not wait for your regular outpatient appointment next week. Keep a careful record of your child's symptoms tonight, and contact your doctor's office first thing in the morning for further assessment.



For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.








 
 
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