Seronegative and septic arthritis Quiz: Ace Your Exams

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A 42-year-old man comes to his primary care PA’s office for evaluation of right knee pain, red eyes, and lesions on soles of his feet. The patient states he had a “urinary tract infection” that was treated with antibiotics 3 weeks ago, and his symptoms appeared shortly thereafter. He has multiple sexual partners, and he uses condoms occasionally. Vitals are within normal limits. Physical examination shows bilateral conjunctival injection with scant purulent discharge at the lid margins. The right knee is mildly swollen with associated tenderness to palpation. Examination of the soles of feet is demonstrated below. Arthrocentesis of the right knee joint shows a leukocyte count of 40,000/mm3 but no organisms on gram-stain or culture. Which of the following is the most likely diagnosis?  


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