An 82-year-old, mildly obese man presented with painful red swollen toes (particularly his second toe) and some pedal redness and pain. His temperature and his WBC count were normal. Thirty years earlier, he had been diagnosed with gout. Over the years he had experienced a half dozen episodes involving acute attacks of skin pain, but it had been three years since his most recent attack. When he presented, he did not have any tophi, and he was not taking allopurinol (Zyloprim) or colchicine. Medications included atorvastatin (Lipitor) for high cholesterol, atenolol (Tenormin) for high BP, and aspirin 81 mg every other day. The patient reported that he drank socially but did not smoke. He had no signs or history of arthritis, and his renal and hepatic function were appropriate for his age.


The patient was an 80-year-old man with a history of painful red lower limbs. The condition kept him awake at night and had been worsening over the past several months. He had a history of essential thrombocytosis for which he underwent periodic phlebotomy, but he had no evidence of polycythemia vera (PV), myelofibrosis, or chronic myelogenous leukemia. Testing for the Philadelphia chromosome was negative. The rest of his history was unremarkable. He did not have hypertension or high cholesterol, and he reported no history of exposure to mercury or lead. His only medication was an occasional aspirin. The patient described himself as primarily sedentary and reported drinking no more than one glass of wine every several days.

What is your diagnosis?

Click “NEXT” for CASE #1 and “3” for CASE #2

Continue Reading