-A 12 years-old, female

-Complaining since birth

-At the age of 8^th month after birth, she had recurrent oral ulcerations hindering her from proper breastfeeding

-Repeated consultations: local treatment

-Then developed genital ulcers besides oral ulcers, diagnosed to have Bechet's disease: given local steroids, colchicine, azathioprine, but no improvement, so she was recommended to receive biological therapy

-On examination:

         -frustrated, depressed girl, also her parents looked in the same manner

         -severe halitosis, mixed-infected oral ulcers

-inability to eat increased with the treatments received: I immediately started to reassure her and her mother and telling them that this ailment will decrease in intensity as she advances in age, but her mother responded that the attacks became continuous, which were intermittent before, preventing her eating normally

-Discussion:

      -To elucidate the condition: this condition is (PFAPA): syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA)

       -In this condition the innate immunity behaves oddly, so we supposed strongly that these attacks will decrease in intensity and frequency as the patient progresses in age towards puberty.

      -Understanding this concept endorsed to cut down the given aggressive immunosuppression treatment, like steroids, which may cause the condition to be in a continuous pattern.

-Strategy: a peculiar treatment strategy especially during the attacks which may shorten her suffering:

                   -to decrease steroids treatment period

                   -just treatment during the attacks, just to relieve symptoms

 -By this strategy, Thanks To Allah, she gave a dramatic response

-It's to be noted that the physical development wasn't markedly hindered, didn't make her handicapped, nor caused growth retardation.

-Really the source of suffering wasn't the ailment itself, but actually it raised from wandering all those years till diagnosis.