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CASE We report a case of acute gouty arthritis-mimicking infection that occurred immediately after right total knee arthroplasty in a 73-year-old man. Repetitive laboratory tests showed acute inflammation and did not easily distinguish acute gout from bacterial infection. Surgical treatment was undertaken for diagnostic and therapeutic purposes. A large amount of chalky whitish crystals suggestive of acute gout was found in both knees without the suspicion of bacterial infection, and thorough irrigation and debridement were performed. CO