Hemarthrosis: Concurrent acute presentation of pyrophosphate dehydrate and uric acid crystals in an elderly patient with a history of rheumatoid arthritis diagnosed with septic arthritis

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Concomitant septic arthritis in the presence of crystalline disease is a rare presentation of acute hemarthrosis and knee pain. Literature review showed that co-occurrence of these entities is an infrequent phenomenon but it needs to be acknowledged that these studies are few in number and were done on small patient population. This case challenges the notion that presence of crystals in the synovial fluid rules out septic arthritis even in the setting of low synovial WBC count. Additionally, the presence of pseudogout in patients suffering from gout is a rare entity as well. These findings in literature are described in case reports dispersed over the past three decades. We present a case where concurrent treatment of gout, pseudogout, and septic arthritis in a patient who presented with acute hemarhtrosis.