Case Discussion: pain in the great toe

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6 Nov 2016 - General

A 35 years old man presented to emergency department with severe pain in his right great toe. The pain is so severe and rapid in onset which compelled the patient to wake up in the early morning. He described it as the worst pain ever. There was extreme tenderness for which he is unable to wear a sock. On examination, there was marked swelling with red shiny skin over first metatarsophalangial joint. There was no pain in any other joint there is no history of injury.

From these clinical features, what is the most probable diagnosis?

What are the investigation required and how will you manage the case?

@[Mahmoud AbdelAziz] You are absolutely right. This is a case of gouty arthritis. It most commonly attack the first MTP joint with a sudden, severe pain. The pain and tenderness become so severe that the patient even can't tolerate touch of clothes . It require urgent pain management with analgesic like NSAID. Colchicine is very helpful. And it may reccur in future. So uric acid lowering drugs are required after management of initial episode.
And yes, @[you hi hong] , septic arthritis i...
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I guess it is most probably gouty arthritis. Gout is a metabolic condition that can affect the big toe joint. Gout occurs when uric acid builds up in the blood, although this does not always cause symptoms. When uric acid forms crystals that deposit into joints, most commonly the big toe, an attack of acute gouty arthritis can occur. Symptoms of gouty arthritis include a red, hot, and intensely painful joint. If gout attacks go untreated and occur repeatedly for a number of years, joint damage m...
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I think the most likely diagnosis will be septic arthritis, given the history of acute onset, with marked swelling over first metatarsophalangeal joint and severe pain on the right great toe. We should check for his full blood count, looking for the elevation of white cell count and neutrophil, also should check for inflammatory markers (CRP and ESR) which will be raised in settling of acute infection and inflammation. Baseline liver function, renal function and electrolytes should be checked. A...
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