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Septic Arthritis — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionSeptic ArthritisSCE Infectious Diseases

A 55-year-old man with type 2 diabetes develops a warm, swollen right great toe with excruciating pain. Synovial fluid shows 42,000 WCC/µL (neutrophil-predominant), negatively birefringent needle-shaped crystals, AND Gram-positive cocci on Gram stain. What is the most appropriate management?

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Correct answer: A — Treat both gout and septic arthritis concurrently: joint washout plus IV Flucloxacillin and manage gout

Gout and septic arthritis can coexist — the presence of crystals does not exclude infection. When both crystals and organisms are identified on synovial fluid analysis, BOTH conditions must be treated simultaneously. Septic arthritis management (joint washout plus IV antibiotics) takes priority given the risk of joint destruction. Gout treatment (Colchicine, NSAIDs, or short-course steroids — avoiding systemic steroids initially if septic arthritis is being treated) should also be initiated.

Reference: NICE NG157 2024 – Septic arthritis; BSR 2017 – Gout guidelines