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63-Year-Old Male with Painful Swelling of Second Toe

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

Three days after the acute onset of pain and swelling of the second toe of his right foot, a 63-year-old man seeks medical care. He denies any trauma. The patient takes no medications.

Which of the conditions in your differential is the likely cause?

Choose one to reveal diagnosis and discussion

Cellulitis
Osteoarthritis
Rheumatoid arthritis
Gout

Answer: Gout

See the full case at Consultant360

In patients with gout, monosodium urate monohydrate crystals accumulate in tissues and joints; most often, a single joint is affected. The disease can be confused with an acute bacterial infection (cellulitis), but gout does not respond to antibiotics. Rheumatoid arthritis and osteoarthritis are less acute and less painful and usually affect multiple joints.

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