25th February 2025

A young man presents to A&E with a fever, malaise, severe pain and swelling in the right hip and left knee and a pustular rash of the lower limbs.

A young man presents to A&E with a fever, malaise, severe pain and swelling in the right hip and left knee and a pustular rash of the lower limbs. He states that some other joints have been painful over the previous week, but not to this extent. On systems review, he admits to some unusual penile discharge a few weeks previously.

FBC shows:

Hb 150 (120-180)

MCV 95 (90-97)

Plts 400 (150-450)

WCC 22 (4-11)

Neutrophils 16.7 (1.5-8)

Lymphocytes 4 (1.1-4)

Monocytes 1 (0.2-1.1)

Eosinophils 0.2 (0.1-0.4)

Basophils 0.1 (0-0.3)

Arthrocentesis of the joints show a purulent fluid. What would you expect the Gram stain to show?

Select the SINGLE most appropriate option from the list below. Select ONE option only.