STILL FEBRILE - A RARE CAUSE OF JOINT PAIN

A 35-year-old woman presented to our emergency department complaining of arthralgia, rash, fevers, and muscle weakness for the past year. These symptoms initially began as unilateral upper lip swelling, which then progressed to a facial rash and orbital swelling over two weeks with associated fevers, which eventually subsided. The patient then began having fluctuating arthralgia and muscle weakness with associated rash and subjective fevers. She had rheumatologic evaluation several months prior to our encounter at another facility, which failed to reveal an explanation for her symptoms. During this workup, antinuclear antibodies (ANA), rheumatoid factor (RF), and complement levels were normal with elevated erythrocyte sedimentary rate (ESR) and C-reactive protein (CRP). On arrival to our hospital, she complained of symmetric polyarthritis involving the ankles, knees, shoulders, and hands, and proximal upper and lower extremity weakness with difficulty rising from a seated position. On examination she was noted to have an evanescent rash on bilateral extremities and her abdomen. Cardiac exam revealed no murmurs. Laboratory testing was significant for anemia, hyperferritinemia, leukocytosis, with negative RF and ANA. Transaminitis was not present. The patient's fevers resolved and her symptoms improved during hospitalization. She was started on prednisone 60mg daily and discharged with follow up in the rheumatology clinic to initiate therapy with the IL-1 antagonist anakinra.