Download - Gout case presentation
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Case Presentation
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Presentation
• 58 yo male
• ED 11/07
• Generalised pain R foot – sole, lateral ankle and dorsum
• Worse at night
• Afebrile
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Clinical Examination
• Vitals Normal
• Painful ++ Right foot
• Tender
• Swelling over lateral ankle malleolus, all MTP’s,sole
• Hot, erythema over lateral aspect
• DP/PT Pulse ++
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Past Hx• Gout• L foot stress fracture 4th metatarsal –
– Cam boot & crutches– Pt been weightbearing on right foot for 1/12
• IHD – stents X5 2005, HTN• Cholesterol• L shoulder replacement and bone graft• L knee arthroscopy X3
ALLERGIES - Iodine
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Medications
• Pantoprazole 40mg Daily• Diazepam 5mg PRN• Fenofibrate 145mg Nocte• Aspirin 100mg Daily• Candesartan/HCT 16/12.5mg Daily• Allopurinol 100mg Daily• Atenolol 50mg Daily• Colchicine 500mcg DailyPast 1/12:- Panadeine forte- Valium PRN for muscle relextant- Voltaren PRN
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Investigations
• UEC- normal
• FBE: Normal
• Neutrophil: Normal
• CRP: 37.6
• Xray for foot
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Treatment Plan
• Colchicine 1mg tds
• Continue allopurinol
• NSAIDs for 3/7
• Gout flare? Septic arthritis?– Given generalised nature of swelling and pain
with no specific joint involved, unlikely septic arthritis
• No WCC/CRP rise
• Elevate and ice foot and see if any improvement.