Gonococcal septic arthritis in a sexually active 24-year-old female is best distinguished from non-gonococcal septic arthritis by which clinical pattern?

• A Monoarthritis of the knee with synovial WBC > 100,000/mm3 and positive blood cultures
• B Bilateral symmetrical arthritis with positive RF and erosions
• C Sacroiliac joint involvement with elevated HLA-B27
• D Migratory polyarthralgia progressing to purulent monoarthritis, tenosynovitis, and a papulopustular skin rash (disseminated gonococcal infection) ✓

Explanation

Disseminated gonococcal infection (DGI) causes a distinct biphasic presentation: bacteraemic phase (migratory polyarthralgia, tenosynovitis, papulopustular or vesiculopustular skin lesions, positive blood cultures) followed by septic arthritis phase (purulent joint effusion, often with negative cultures). It is the most common cause of septic arthritis in sexually active young adults. Non-gonococcal septic arthritis (Staphylococcus) typically presents as acute monoarthritis without the migratory or skin features.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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