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.
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