A 28-year-old Bangladeshi male presented with two weeks history of fever (temperature 39.0 C) and bilateral knee and left ankle pain and swelling.
Laboratory workup showed leukocytosis (WBC 23 x 103\microl), very high CRP (278 mg\l), and elevated ESR 42 mm/hr. His left knee synovial fluid (SF) WBC count was 12,188/microl. Blood and synovial fluid cultures were negative, and TB QuantiFERON was negative. Later, his HLAB27 came back positive; as he continued to spike a fever, a CT scan of the abdomen was done which showed mild hepatosplenomegaly; bone marrow aspiration revealed no infection or malignancy. After excluding infection as a cause of his fever, a trial of diclofenac potassium 50 mg BID was given and intraarticular 80 mg methylprednisolone was injected into his left knee.
He was diagnosed with peripheral spondyloarthritis and methotrexate, and then adalimumab were started with good control of his disease.