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In traditional teaching, synovial fluid cell counts over 50 000/mm3 are in keeping with septic or crystalline arthritis. We report a patient with adult-onset Still’s disease (AOSD) and associated inflammatory arthritis whose synovial fluid cell count was over 80 000/mm3. This is the highest level reported in the literature, demonstrating that in the appropriate clinical context, markedly elevated synovial cell count levels over 50 000/mm3 can be caused by inflammatory conditions like AOSD. Recognition of this is crucial to avoid inappropriate antibiotics and procedures while also ensuring correct immunosuppressive treatments are offered in a timely manner.

A patient presented with ataxia with cerebellar dysfunction on examination. After lung imaging revealed a large consolidation, the patient was eventually diagnosed with Legionnaires’ disease during admission. The imaging and case demonstrate how clinicians must include Legionella on their differential diagnosis when there is a combination of respiratory and neurologic pathologies, even when respiratory symptoms are not the presenting concern. RésuméUn patient présente une ataxie accompagnée d’un dysfonctionnement cérébelleux révélé à l’examen. Après que l’imagerie pulmonaire ait révélé la présence d’une consolidation importante, le patient a finalement reçu un diagnostic de légionellose lors de son admission. L’imagerie et le présent cas montrent aux cliniciens la nécessité d’inclure la légionelle dans leur diagnostic différentiel en présence d’une combinaison de pathologies respiratoires et neurologiques, même lorsque les symptômes respiratoires ne sont pas la principale préoccupation.