Three mL of purulent yellow fluid is aspirated. The fluid is sent for culture, cell count, and gram stain. He is given oxacillin intravenously. Laboratory studies performed on the arthrocentesis fluid: WBC 22,100, 2% bands, 78% segs, 6% lymphs, 14% monos, RBC 373,000. Gram stain: many WBC's, no organisms. The patient is hospitalized for intravenous antibiotics for septic arthritis. The next day, the culture of the ankle joint aspirate is positive for Streptococcus pneumoniae. He has a bone scan which shows increased uptake of the right talus. He undergoes a right ankle arthrostomy, synovial biopsy, curettage and windowing of the talus for septic arthritis AND osteomyelitis. He has a Penrose drain placed. A repeat ESR is 40. The blood culture is negative. The right ankle surgical wound heals well without complications.