Cellulitis is notable for local skin erythema, induration, and tenderness. The adjacent joint has relatively preserved motion and is less tender. Lymphangitis or regional lymphadenitis is commonly encountered with cellulitis. Often the patient or examiner will note the presence of a minor abrasion, laceration, puncture, or furuncle within the cellulitis, serving as an entrance site for local invasion of bacteria.
Hemarthrosis can rarely pose a problem in the differential diagnosis of septic arthritis. In the absence of a history of trauma, a congenital or acquired coagulopathy is suspected (hemophilia A, factor IX deficiency, Von Willebrand disease, leukemia, etc.). Henoch-Schonlein purpura may present with one or more painful joints prior to manifestation of the other cardinal symptoms of the disease (abdominal pain, nephritis, purpura). The arthralgia with this condition is migratory, however, and represents a periarticulitis rather than an actual arthritis. If the joint of involvement happens to be the hip, a diagnosis of Legg-Calvé-Perthes disease may come to mind. This condition is not, however, associated with high fever, systemic signs of illness, and prostration, and the examination and culture of the synovial fluid will easily distinguish this condition from septic arthritis.
The management of acute suppurative arthritis consists of (1) establishing the diagnosis by obtaining synovial fluid from the infected joint for Gram stain and culture as well as other microscopic and laboratory studies; (2) drainage of the infected joint of bacterial products and infectious debris [suppurative arthritis of the hip requires open surgical drainage (arthrotomy), while more superficial joints can frequently be drained arthroscopically or even through arthrocentesis]; (3) emergent initiation of appropriate initial antibiotic therapy ( Table... ,.132z2.); and (4) local care of the joint (support by skin traction for larger joints; splinting of the wrist, ankle, and smaller joints).
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