MTP Septic arthritis due to non-tuberculous mycobacterium without effusion We had an immunosuppressed patient with a concerning 1st MTP. History of gout. But concern for septic arthritis. Clinically no effusion, sonographically no effusion. Extremely difficult case to get any fluid. Here's my takeaways 1) even with gout, worry about septic arthritis. Especially if immunosuppressed 2) no effusion doesn't mean no septic arthritis 3) ultrasound can help you get even the seemingly impossible tap. 4) we only got enough fluid to fill the hub of the needle. Couldn't even get it into the syringe. What do you do? No-one wanted to send a sharp to the lab! We called the lab. They would have diluted the fluid. we used their preferred diluent and aspirated the drop into the syringe 5) Finally, mycobacteria. Definitely not a common bug. Probably explains the patient's smoldering course. https://pubmed.ncbi.nlm.nih.gov/330 - Dr. Vivian Lam and Dr. Nik Theyyunni @HeyDrNik #Septic #arthritis #mycobacterium #clinical #pocus #joint #MTP #finger
