The second toe of an 81-year old woman who was using diuretics for heart failure was markedly swollen, red and tender. An abscess could not be excluded on clinical grounds. After local anaesthesia of the skin, an incision yielded plenty of pearl-white fluid consisting of chrystals, confirming the diagnosis of gout. If the fluid is examined by native microscopy, masses of needle-like chrystals can be seen. The pain was alleviated after the incision. Plasma urate level exceeded 700 µmol/l. The patient received a prescription of allopurinol.
Tophaceous gout