Septic Arthritis: The Daily PANCE Blueprint

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Septic Arthritis: The Daily PANCE Blueprint

A 31-year-old male presents with sudden onset of pain and swelling in his right ankle. On physical exam, you appreciate a warm, swollen, and erythematous ankle. The joint was aspirated, and the synovial fluid shows 55,000 WBCs, 80% polymorphonuclear leukocytes, low glucose levels, and no crystals. Cultures are pending at the time. Which of the following is the most likely diagnosis based on the information above?

A. Osteoarthritis
B. Septic arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Gouty arthritis

Answer and topic summary

The answer is B. Septic arthritis

Septic arthritis is an infection of the joint space due to bacteria. It can occur at any age, although the incidence is higher in elderly and very young people. Etiologies include Staphylococcus aureus, Streptococcus spp., N. gonorrhoeae (in young, sexually active adults). Septic arthritis either happens due to hematogenous spread or direct inoculation by microorganisms s/t trauma or iatrogenesis (e.g., joint surgery). Clinical features include joint pain/swelling, warmth, and decreased ROM. The gold standard for diagnosis is synovial fluid analysis (Although make sure to note WBC count alone is insufficient to rule in or out septic arthritis). Patients should be given IV antibiotics (4–6-week course).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Infectious Diseases ⇒ Septic arthritis

Also appears on the Emergency Medicine content blueprint for EOR exams