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Septic arthritis diagnosis — SCE Rheumatology MCQ

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HardMusculoskeletal investigationsSeptic arthritis diagnosisSCE Rheumatology

A 51-year-old man has an acutely swollen ankle. Synovial fluid is cloudy with WBC 64,000/mm^3, neutrophil predominance and no crystals seen; Gram stain is negative. He is febrile and has a prosthetic aortic valve. What is the most appropriate management?

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Correct answer: B — Treat as septic arthritis while awaiting cultures

A negative Gram stain does not exclude septic arthritis, especially with fever, high synovial WBC and prosthetic valve risk. Urgent antibiotics after cultures and joint drainage are required. Steroid injection before excluding infection can be dangerous.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions