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Transcript
3. What is your Initial Impression and give your Differential Diagnosis. 3. What is your Initial Impression? Patient: Immunocompromised ill looking Fever and chills Left Knee: + trauma Abrupt in onset < 2weeks (acute) Unilateral pain and swelling, warm Limited range of motion SEPTIC ARTHRITIS probably bacterial infection SEPTIC ARTHRITIS Occurs as a result of hematogenous seeding of infectious organism in the synovial fluid Consequence of inflammatory reaction joint cartilage and synovial are damage by the proteolytic enzymes and mechanical factors. Common in young children SEPTIC ARTHRITIS Etiologic Agent: Staphylococcus aureus (most common) Gonococcal (sexually active) Candida (disseminated infection) Viral (systemic infection) SEPTIC ARTHRITIS Infection of joints are followed by Penetrating injuries: Trauma Arthroscopy Prosthetic Joint Surgery Intra-articular Steroid Injection Orthopedic Surgery Differential Diagnosis Juvenile Rheumatoid Arthritis Onset < 16 y/o Persistent arthritis in at least one joint for 6 weeks polyarticular course and functional disability symmetric, large and small joints Exclusion for other diagnoses Girls > boys production of JRA – causes synovial inflammation, bone erosion, fever, rash, joint destruction; can be treated with biologic agents Differential Diagnosis Systemic Lupus Erythematosus An episodic, multisystem, autoimmune disease Widespread inflammation of blood vessels and connective tissues Intermittent Polyarthritis Mild from disabling Characterized by soft tissue swelling and tenderness in joints of the hands, wrist, and knees Presence of autoantibodies (hallmark of SLE) Differential Diagnosis Drug induced: Glucocorticoid treatment Can cause osteopenia and osteonecrosis Hydrochloroquine Can cause osteonecrosis