A 19-year-old female exchange student presents to the emergency department with severe abdominal pain and a swollen right knee. She has had recurrent episodes of abdominal pain for the past 5 years that last for 2 to 3 days. Previous investigations, including radiographs, CT, endoscopy, and an exploratory laparoscopy, have all failed to identify a cause. On examination, she has a temperature of 39.4°C and a heart rate of 125, and her abdomen is diffusely tender with rebound tenderness. A right knee effusion is present, and a raised, tender erythematous lesion on her left lower leg is noted. Laboratory testing reveals an elevated white cell count with a neutrophilic predominance, as well as elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum amyloid A (SAA) protein. A favorable response to which of the following medications supports this patient’s most likely diagnosis? Learn more about this case, take the quiz, and join the conversation on Figure 1.
This article originally appeared here.
Submit your diagnosis to see full explanation.
Learn more about this case, and join the conversation on Figure 1.