Image of the Week: Severe Abdominal Pain and Knee Swelling

A 19-year-old exchange student presents to the emergency department with severe abdominal pain and swelling of the right knee. She has experienced recurrent episodes of abdominal pain for the past 5 years that persist for 2 to 3 days before resolving spontaneously. Previous investigations, including radiography, computed tomography, endoscopy, and an exploratory laparoscopy have all failed to identify a cause. She mentions that several family members who still reside in Turkey experience similar symptoms. On examination, she has a temperature of 39.4°C and a heart rate of 125 beats per minute. Her abdomen is diffusely tender with rebound tenderness. Effusion of the right knee is present, and a raised, tender, erythematous lesion on the lower portion of her left leg is noted. Laboratory testing reveals an elevated white cell count with a neutrophilic predominance as well as an elevated erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A 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.

The Image of the Week for June 2 is brought to you in partnership with: