A 55-year-old woman presented with symptoms red, hot, swollen knee. The patient has a medical history of monoarticular arthritis and was on intermittent medication by steroid injections and NSAIDs.
She was reported with a negative evaluation of rheumatologic disease. Physical examination CBC Normal Comprehensive metabolic panel Normal Erythrocyte sedimentation rate 60 mm/hr C-reactive protein 41 mg/dL Synovial fluid WBC count Polymorphonucleocytes Lymphocytes Monocytes RBC count Protein Glucose Gram stain and culture 1919/µL 26% 68% 5% 80,000/µL 4.9 g/dL 77mg/dL Negative Chest X-ray Inferolateral mild pleural thickening Knee X-ray No signs of osteomyelitis; cystic degenerative changes Pathology Necrotizing granulomas with no fungal or acid-fast bacilli observed on special stains