WEFOUNDA Quotidian Dilemma

October, 1998:  The 22 year old (18 years at this time) patient experienced her first episode of severe pain and swelling of both knees of 4 days duration. The pain resolved with ibuprofen.

January, 1999:  Her left wrist became erythematous and swollen, and she was eventually bedridden due to right knee swelling not relieved with ibuprofen. Four days later, she reported to a local emergency room complaining of daily spiking fevers (as high as 102.6 in the evening) and chills. Upon further questioning, she reported a 30-pound unintentional weight loss over the prior 3 months. She was admitted to the community hospital. Her right knee was aspirated and broad- spectrum antibiotics are instituted.

January, 2002:  She returned to the local emergency room with complaints of wrist and knee pain and daily fevers for the past week. She was given antibiotics and aspirin and discharged. Three weeks later, she returned to the hospital and was admitted with arthralgias, fever, myalgias, pharyngitis, and pre-syncope.