关节内痛风引起的白细胞计数明显升高.pdfVIP

n Case Report Markedly Elevated Intra-articular White Cell Count Caused by Gout Alone Brian M. Schulz, MD; Jonathan P. Watling, MD; J. turner VoSSeller, MD; roBert J. Strauch, MD abstract Full article available online at H/Orthopedics Joint pain accompanied by erythema, swelling, and decreased range of motion is concerning for septic arthritis and typically warrants joint aspiration. The synovial fluid white blood cell count plays a central role in the decision-making process regarding these patients. Traditional teaching holds that a cell count greater than 50,000 white blood cells/µL is likely caused by infection and therefore warrants ei- ther operative intervention or serial aspiration. This report describes 2 patients with extremely high synovial fluid white blood cell counts in the absence of infection. Case 1 involved a 59-year-old man who presented to the emergency department with sudden onset of atraumatic left elbow pain and was found to have a white blood cell count of 168,500 white blood cells/µL on joint aspiration and innumer- able monosodium urate crystals. The patient ultimately improved with treatment with oral prednisone, avoiding operative intervention. Case 2 involved a 69-year- Figure: Preoperative anteroposterior radiograph of old man who presented to the emergency department with acute onset of atrau- the left elbow showing joint effusion but no evi- matic left knee pain. On arthrocentesis, the patient had a cell count of 500,000 dence of trauma. white blood cells/µL and was therefore taken to the operating room for arthroscop- ic irrigation and debridement. Final analysis of the synovial fluid showed mono- sodium urate crystals and negative culture findings. These cases