Immediate "steroid flare" from intraarticular triamcinolone hexacetonide injection: case report and review of the literature. 
We describe a patient who had an immediate, intense, localized synovitis due to intraarticular triamcinolone hexacetonide injection.  The reaction was secondary to rapid intracellular ingestion of the steroid microcrystals as demonstrated by compensated polarized microscopy.  We report the unique nature of this patient's response, and we review previous literature regarding "steroid flare" after intraarticular injection.