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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Septic Arthritis
Mary E. Margaretten, Jeffrey Kohlwes, Dan Moore, Stephen Bent
Clinical Scenario

Topics Discussed: arthritis, infectious, arthritis, monoarticular, arthritis, rheumatoid, arthrocentesis, bacterial arthritis, diabetes mellitus, diagnosis, differential, diagnostic process, hypertension, leukocyte count, neutrophils

Excerpt: "A 48-year-old woman with a history of rheumatoid arthritis who has been treated with long-term, low-dose prednisone presents to the emergency department with a 2-day history of a red, swollen left knee that is painful to touch. She reports no prior knee swelling and no recent trauma or knee surgery, illegal drug use, rash, uveitis, or risky sexual behavior. On examination, she is afebrile and has a left knee effusion. Her peripheral white blood cell (WBC) count is 11 000/L and her erythrocyte sedimentation rate (ESR) is 55 mm/h. An arthrocentesis is performed and initial laboratory test results show a negative Gram stain, a synovial fluid WBC count of 48 000/L, and the fluid culture is pending. What is the likelihood of septic arthritis in this patient?..."
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