A patient was admitted for community-acquired pneumonia, and mechanical ventilation was necessary. Staphylococcus aureus and Legionella pneumophilla were identified as aetiological agents of lobar pneumonia. Sepsis developed and was managed.
During the convalescence, period fever appeared again. Levels of inflammatory markers were elevated. Lung´s condition seemed to improve. The patient complained of pain in the left elbow and ankle.
Physical examination
Elbow: olecranon bursa could be palpated (tumor), rubor, dolor and calor. Pale solid structures (tophi) could be palpated under the skin above the proximal part of the ulna. There was a small haemorrhagic crust above convexity of the olecranon. Movements were restricted (functio laesa) – extension 70° at most, flexion 90° at most, rotation without restriction.
Ankle: oedema, redness and pain occurring during palpation ventrally to the talocrural joint, fluctuation could
Ultrasonography: