Why Is This Man’s Toe Painful, Swollen, and Red?

Author: David L. Kaplan, MD—Series Editor University of Missouri Kansas City, University of Kansas Citation: Kaplan DL. Why is this man’s toe painful, swollen, and red? Consultant. 2013;53(5):310,312.    Three days after the acute onset of pain and swelling of the second toe of his right foot, a 63-year-old man seeks medical care. He denies any trauma. The patient takes no medications.   Which of the conditions in your differential is the likely cause?A. CellulitisB. OsteoarthritisC. Rheumatoid arthritisD. Gout (Answer and discussion on next page)   ,   ANSWER: Gout In patients with gout, D, monosodium urate monohydrate crystals accumulate in tissues and joints; most often, a single joint is affected. The disease can be confused with an acute bacterial infection (cellulitis), but gout does not respond to antibiotics. Rheumatoid arthritis and osteoarthritis are less acute and less painful and usually affect multiple joints.   David L. Kaplan, MD, is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kansas.