Case 4
A 58 years old male farmer worker (bilharzial exposure and treatment including splenectomy ).
He was quite well up to 3 weeks ago when he developed fever, polyarthritis (both knees, ankles and wrists),generalized bony aches especially the lower back and also developed asthenia, easy fatigue, and weight loss .So he sought medical advice at different specialties with no improvement in spite of taking many and various medications .
summary of positive clinical findings:
-Ill patient, feverish(39°C), polyarthritis affecting the above mentioned joints, also there are bilateral knee effusion and significant movement limitation of the affected joints and low back tenderness.
Investigations:
-LABs:↑ESR, Normal CBC, +ve HCV antibodies, normal transaminases ,serum albumin, α-fetoprotein and CEA within normal range also Anti-ccp, ANA, Widal and Brucillosis.
Ultrasonography :
-Periportal fibrosis, splenectomy, no ascites nor enlarged lymph nodes.
Plain chest X-ray: showed no abnormalities.
What is the approach to deal with this patient?
