Specialty results

Bloodwork indicates a microcytic, normochromic anemia, probably due to iron 
sequestration by the macrophages in an effort to fight the bacterial infection. Iron is 
sequestered to keep the bacteria from using it. A thrombocytosis is evident due to cross 
linking of erythropoietin. Hyperproteinemia and hyperfibrinogemia are evident due to the 
production of acute phase proteins.  The joint fluid contained a moderate amount of 
leukocytes (PMNs) and a slight increase in total protein (normal is ~2). The presence of 
Klebsiella pneumoniae indicates that bacteria is present in this area Klebsiella 
pneumoniae can be a cause of septic arthritis.  The moderate number of leukocytes, total 
protein in the joint fluid and good mucin clot indicates that the joint capsule is not the 
area primarily affected; rather the problem is occurring in the bone itself.

The radiographs indicate an area of periarticular bone lysis along the outer margins of the 
growth plate of the metacarpal bone.  Septic arthritis and perhaps osteomyelitis of the 
growth plate may be present.