04-06-2008, 08:59 PM
A 28-year-old black woman with sickle cell anemia is evaluated for a 2-day history of progressive left ankle pain. Her pain is so severe she is now using crutches to ambulate. She has no history of inciting trauma. She is sexually active. Joint pain has been a manifestation of her sickle cell crises since adolescence.
On physical examination, she is afebrile. The left ankle is warm and swollen. On musculoskeletal examination, there is pain with passive flexion and extension of the ankle joint. Squeezing the midfoot does not elicit pain.
Arthrocentesis of the ankle yields 2 mL of yellow fluid (leukocyte count, 18,000/µL [18 × 109/L]; 88% neutrophils). Polarized light microscopy of the fluid shows no crystals, and Gram stain for bacterial organisms is negative. Results of fluid cultures are pending.
Which of the following conditions should be initially treated in this patient?
A Sickle cell arthropathy
B Avascular necrosis
C Gouty arthritis
D Septic arthritis
On physical examination, she is afebrile. The left ankle is warm and swollen. On musculoskeletal examination, there is pain with passive flexion and extension of the ankle joint. Squeezing the midfoot does not elicit pain.
Arthrocentesis of the ankle yields 2 mL of yellow fluid (leukocyte count, 18,000/µL [18 × 109/L]; 88% neutrophils). Polarized light microscopy of the fluid shows no crystals, and Gram stain for bacterial organisms is negative. Results of fluid cultures are pending.
Which of the following conditions should be initially treated in this patient?
A Sickle cell arthropathy
B Avascular necrosis
C Gouty arthritis
D Septic arthritis