A 23-year-old Nepalese male presented with 10 days history of fever (temperature 38.6 C) and acute left knee pain and swelling. Laboratory tests revealed leukocytosis (WBC 15 x 103microl) and very high CRP 195 mg\l. His left knee synovial fluid analysis showed WBC count of 55,375/microl, and no crystals were seen. The patient underwent arthroscopy and washout, and IV antibiotic was started. His blood cultures and synovial fluid cultures were negative. Blood TB gold QuantiFERON and synovial fluid PCR for TB were negative.
Three weeks after discharge, he presented to the clinic with recurrent left knee effusion and he started developing right knee pain and mild swelling.
His inflammatory arthritis workup revealed positive HLAB-27. His sacroiliac joint MRI was normal.
The diagnosis of peripheral spondyloarthropathy was made. He was given an intraarticular steroid injection in his left knee, and sulfasalazine was started. During his subsequent follow-up visits, he had a very good response and no more attacks of arthritis were observed.