Toed

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.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 16,000/mm3 (4,000-11,000)
Hb: 13.4 mg/dl
Platelets: 256,000/mm3 (150,000-400,000)
Uric Acid

Performed

Serum Uric Acid: 7.4 mg/dl (<6.8 mg/dl)
Joint Fluid Aspiration

Performed

Appearance: clear
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

Performed

Urea: 5.5 mmol/L (2.5-6.7)
Creatinine: 1 mg/dl (0.8-1.4)

Select Relevant Management
IV Antibiotics
NSAIDs
Reduce drinking
Allopurinol