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mm/hr), IgG (2,089 mg/dL; reference range, 861-1,747 mg/ dL), IgA (644 mg/dL; reference range, 93-393 mg/dL), and IgM (277 mg/dL; reference range, 33-183 mg/dL). Tests for antinuclear antibody, anti-neutrophil cytoplasmic antibody, and anti-cyclic citrullinated peptide antibody were negative. Blood culture was negative. Written informed consent was obtained. What is the most likely diagnosis? Answer to the Images: CD Complicated by Dactylitis and Pelvic Enthesitis Physical examination showed dactylitis involving the fingers of both hands (Fig. A). CD complicated by dactylitis and pelvic enthesitis around the right hip joint was diagnosed and treatment with 60 mg/day of prednisolone was initiated. Symptoms and inflammatory parameters improved in several days and then prednisolone was tapered. He has been asymptomatic during 2 years of follow-up with infliximab. Musculoskeletal complication is a common extraintestinal manifestation of CD, classified into axial spondyloarthritis (SpA) and peripheral SpA. Axial SpA includes ankylosing spondylitis and non-radiographic axial SpA, whereas peripheral SpA consists of peripheral arthritis, enthesitis, and dactylitis. 1 Although the immunological mechanisms of "gut-joint" axis have not become clear, it is speculated that both bacterial antigens and reactive T-cell clones, activated into the gut home the joint in associa