Thank you Dr. John Hollowed for a great presentation of a pain with acute onset R. shoulder and L. knee pain/swelling s/p arthrocentesis c/w infectious process (gram stain with GPC’s, WBC >200K). Patient also likely with native valve endocarditis

Teaching Points: 

–Septic arthritis an orthopedic emergency! Consult ortho as patient may require surgical irrigation and debridement

–Oligoarticular or polyarticular infection occurs in approximately 20 percent of septic joint infections, usually involving two or three joints.

–Endocarditis should also be suspected when septic arthritis due to Staphylococcus aureus, enterococci, or streptococci occurs in a patient without an obvious predisposing cause. In most cases, bacterial arthritis arises from hematogenous spread to the joint.

–Synovial Fluid Analysis: WBC 0-200 (normal); 200-2000 (noninflammatory); 2000-50000 (inflammatory); >50,000

–Predisposing factors: Age >80 years; DM; RA; Presence of prosthetic joint; Recent joint surgery; Skin infection; IVDU, alcoholism; Prior intraarticular corticosteroid injection