Case Presentation

Presentation

• 58 yo male

• ED 11/07

• Generalised pain R foot – sole, lateral ankle and dorsum

• Worse at night

• Afebrile

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 ++

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

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

Investigations

• UEC- normal

• FBE: Normal

• Neutrophil: Normal

• CRP: 37.6

• Xray for foot

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.