A 30 year-old man is admitted to casualty with a 24 hour history of a painful and swollen right knee. He denies any previous history of joint problems. Over the last two days, he has also noticed redness and soreness in both eyes. He has returned from a business trip to Kuala Lumpur a fortnight ago.
On examination, his temperature is 38.5°C. His eyes are red. His right knee is hot, swollen and tender to palpate. No other joint appears to be affected.
Investigations:
Hb 12.9 g/dl
WBC 14.0 x 109/l
Platelets 200 x 109/l
ESR 75 mm/h
Blood cultures
No growth after 48 hours
Urinalysis
No blood, glucose or protein detected
Knee x-ray
Soft tissue swelling around left knee
What is the most likely diagnosis?
1 )Gout
2 )Gonococcal arthritis
3 )Reiter's syndrome
4 )Rheumatoid arthritis
5 )Viral arthritis
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