case report opeN access www.edoriumjournals.com International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Acute onset small joint affliction in ankylosing spondylitis: A red herring Deepak Rath, Bijit Kumar Kundu ABSTRACT Introduction: Monoarthritis has many a diagnostic possibilities. When acute, it is alarming and usually presents to the orthopedician for initial evaluation. When the most common aetiologies of infection, trauma, and crystals are ruled out, it becomes a diagnostic challenge in itself. Case Report: We present such a case where acute small joint monoarthritis was the presenting symptom in a young male. Detailed history and evaluation led us to diagnose it as the initial peripheral articular manifestation of ankylosing spondylitis. Conclusion: The role of a detailed history keeping in mind the variety of disorders, both autoimmune and non-autoimmune which can present as such cannot be over emphasized. We reviewed the literature to fnd that such a manifestation has not been described before. This case challenges the established pattern of presentation of a relatively ‘known’ entity. (This page in not part of the published article.)