septic arthritis ( RID3615 )
Temporal history is confusing. Started in February. Since then, he has been diagnosed and treated for Syphilis, with the rash on the sole of the affected foot. The referrer thought swelling was along the course of the PTT. Her XRs show narrowing of the TNJ, normal BMD. MRI shows marked BME of the talus, navicular and calcaneus with severe TNJ narrowing and erosions and marked periarticular inflammation, but little or no joint fluid. Despite being insured, the patient refuses US guided aspiration or possible synovial biopsy because he cannot afford the co-pay or the cost of pathology (we offered to deeply discount our co-pay, but combined with the cost of pathology, it was simply too much). Can this be presumed to represent syphilitic arthritis and treated as such? Ive never made this diagnosis.

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