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Gout case presentation

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Vignesh Gk

Case presentation '' Gout"

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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 Daily Past 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.

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Gout case presentation

  • 2. Presentation • 58 yo male • ED 11/07 • Generalised pain R foot – sole, lateral ankle and dorsum • Worse at night • Afebrile
  • 3. 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 ++
  • 4. 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
  • 5. 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 Daily Past 1/12: - Panadeine forte - Valium PRN for muscle relextant - Voltaren PRN
  • 6. Investigations • UEC- normal • FBE: Normal • Neutrophil: Normal • CRP: 37.6 • Xray for foot
  • 7. 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.