A 33-year-old man is seen in the Emergency Department with a hot red swollen right knee. He is normally fit and well with no significant past medical

Subject
Medicine
System
Rheumatology/Orthopedics & Sports

DianaZ

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A 33-year-old man is seen in the Emergency Department with a hot red swollen right knee. He is normally fit and well with no significant past medical history. He admits to drinking at least 40 units of alcohol per week. He has a temperature of 37.7 C, there are two white nodules on the olecranon of his left elbow.
Haemoglobin: 144 g/L
White cell count: 12.6.
Platelets: 123.
ALT: 120. ALP: 140.
Albumin: 37. Gamma GT: 326.
Which of the following is the most likely diagnosis?


A. Acute gout
B. First presentation of rheumatoid arthritis
C. Gonococcal arthritis
D. Osteoarthritis
E. Septic arthritis

Explanatory Note:
The most likely diagnosis is acute gout in view of the high alcohol consumption and the gouty tophi at his left elbow.
 
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