A 45 year old sexually active homosexual male has a history of repeated attacks of pain in a single joint followed by warmth, swelling,

Question Number 0550

Question:
A 45 year old sexually active homosexual male has a history of repeated attacks of pain in a single joint followed by warmth, swelling, reddish discoloration and marked tenderness. 2 ml of fluid are aspirated from the joint and found to have a normal glucose level. An examination of synovial fluid using a polarized light microscope demonstrated crystals in both the synovial fluid and in cells within the aspirate. These crystals appeared to be needle-shaped and strongly negatively birefringent under polarized light. The most likely diagnosis is

a) Staphylococcus aureus
b) gonococcal infections
c) Borrelia burgdorferi
d) Gout
e) Pseudogout


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