50-Year-Old Woman With Bilateral Knee Pain and Swelling

A month after being diagnosed with gout and treated with [[{"type":"media","view_mode":"media_crop","fid":"25501","attributes":{"alt":"diabetic myonecrosis","class":"media-image media-image-right","height":"163","id":"media_crop_6903341663368","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2331","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image","width":"169"}}]]colchicine, a 50-year-old African American woman was admitted with constant bilateral knee and thigh pain and swelling of both knees, all of one week’s duration.

The pain was not relieved with hydrocodone/acetaminophen, and had caused weakness and subsequent falls. Bilateral knee effusions were present. Both legs were tender to palpation, particularly at the distal thigh and knee, but there was no erythema.

Arthrocentesis of the knee revealed blood in the aspirate but no uric acid crystals. No organisms were found on Gram stain or culture. MRI of both knees (see above) showed extensive edema in the distal thigh and gastrocnemius muscles as well as in subcutaneous fat.

The patient, who had diabetes and hypertension, was afebrile but had tachycardia. She denied trauma, fever, chills, nausea, and vomiting, but noted that her vision had been blurry for 3 days.

Can you guess the diagnosis?

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