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Monosodium urate crystal formation
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Salmonella infectious arthritis
Staphylococcus infectious arthritis
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Borrelia infectious arthritis
Osteoarthritis
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This patient's clinical presentation and laboratory findings are consistent with septic arthritis. In this case, the gram-positive cocci in clusters hint at the most common cause, Staphylococcus aureus. Adults typically present with septic arthritis following direct inoculation (such as patients who have had surgery) or hematogenous spread (such as IV drug users). They normally present with high fevers, tender and painful joints susceptible to pain with micromotion, and fluid aspirate that is cloudy. Cell counts of over 50,000 cells/mm^3 strongly suggest septic arthritis when awaiting Gram staining and cultures. Illustration A shows monosodium crystals that would be found in gout as described below. Incorrect Answers: Answer 1: Gout occurs with monosodium urate crystals in the setting of a previous history of the disease or with concurrent diseases such as diabetes and hyperlipidemia. It typically presents with negatively birifringent needle-shaped crystals on peripheral smear of joint fluid. Answer 2: Salmonella infectious arthritis most commonly occurs in immunocompromised patients, especially sickle cell patients. It would present with gram-negative bacilli on the peripheral smear. Answer 4: Borrelia infectious arthritis, or Lyme arthritis, presents commonly after a bite from the ixodes tick and typically is a monoarthropathy that affects the knee. It would present with a WBC count of between 10,000 and 100,000 cells/mm^3 on joint aspirate, but would be less likely in this patient based on the Gram stain. Answer 5: Osteoarthritis would not present with any joint fluid abnormalities. The joint fluid would be clear, viscous, with no inflammatory cells.
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