Practice question

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A 35-year-old man presents with a 2-day history of a painful, swollen, red right knee. He denies any trauma. Aspiration of the knee joint reveals synovial fluid with a white cell count of 80,000/mm³, predominantly neutrophils. Gram stain is negative but microscopy under polarised light shows negatively birefringent, needle-shaped crystals. What is the most likely diagnosis?

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