Question

A chronic alcoholic patient presents with acute pain and swelling of the left great toe. There is no history of trauma. Synovial fluid analysis shows raised leukocytes. Lab investigations show normal serum uric acid levels. What is the most likely diagnosis?

• A. Pseudogout
• B. Acute gout
• C. Reactive arthritis
• D. Septic arthritis

Answer 1

The Correct Option is B

The clinical presentation involves a chronic alcoholic patient who experiences acute pain and swelling of the left great toe. The absence of trauma and the synovial fluid analysis showing raised leukocytes suggest an inflammatory process. Despite normal serum uric acid levels, the most likely diagnosis is Acute gout. Here is the reasoning:

1. Clinical Symptoms: The sudden onset of pain and swelling in the great toe is characteristic of gout, commonly affecting the first metatarsophalangeal joint.
2. Patient History: Chronic alcohol consumption is a risk factor for gout due to increased uric acid production and possibly decreased excretion.
3. Synovial Fluid Analysis: Raised leukocytes indicate inflammation, often seen in gout. It's important to note that while uric acid may be normal between attacks, the uric acid crystals can still precipitate in joints causing acute symptoms.
4. Exclusion of Other Diagnoses:
   • Pseudogout typically affects larger joints and is diagnosed with calcium pyrophosphate crystals, not suggested here.
   • Reactive arthritis usually follows infections and often involves conjunctivitis or urethritis.
   • Septic arthritis would likely present with systemic symptoms like fever, and synovial fluid would show organisms on culture.

Thus, considering the patient's risk factors and clinical presentation, acute gout is the most probable diagnosis despite normal uric acid levels.