A 45 year old man presents with excruciating pain, redness and swelling of his right big toe. There is no history of trauma.
His medical history is unremarkable, and he is not on any drugs. He smokes 1 to 2 cigarettes each day and drinks around 10 to 12 units of alcohol each week.
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Full Blood Count
WBC: 16,000/mm3 (4,000-11,000)
Hb: 13.4 mg/dl
Platelets: 256,000/mm3 (150,000-400,000)
Serum Uric Acid: 7.4 mg/dl (<6.8 mg/dl)
Joint Fluid Aspiration
WBC: 2300/uL, with a predominance of polymorphonuclear leukocytes
Polarized light microscopy: Uric acid crystals are seen
Microscopy: no abnormalities
Gram stain: negative
Culture results will be available in 3 days
Urea & Creatinine
Urea: 5.5 mmol/L (2.5-6.7)
Creatinine: 1 mg/dl (0.8-1.4)
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