BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j250 (Published 09 March 2017) Cite this as: BMJ 2017;356:j250
  1. Gayathri Nayar, medical microbiology specialty registrar,
  2. Mahableshwar Albur, medical microbiology consultant
  1. Microbiology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
  1. gnayar2012{at}gmail.com

A 58 year old female nurse presented with a two month history of fever and excruciatingly painful swelling of the small joints of the hands …

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