A 42-year-old man with rheumatoid arthritis on methotrexate presents with acute knee pain, swelling, and fever. Synovial fluid shows WBC 62,000/μL with 88% neutrophils, negative Gram stain, and negative culture after 48 hours. Which single feature best distinguishes acute bacterial septic arthritis from crystal-induced arthritis (gout) in this immunocompromised host?

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