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An alcoholic patient presents with painful & swollen 1st MTP. Aspiration reveals increased leukocytes of 2000 cells per cumm. There is no history of travel dysuria, dysentery, sexual contact in patients. BUN & serum uric acid is normal. Clinical diagnosis is
A . Acute gouty arthritis
B. Reactive arthritis
C. Septic arthritis
D. Pseudogout
Correct Answer - A
Explanation
Acute gouty arthritis: Gout is a crystal arthropathy due to monosodium urate crystal deposition. The most commonly affected joint is the first metatarsophalangeal joint the big toe, which matches the patient's presentation. Acute gouty attacks are characterized by rapid onset of severe joint pain, swelling, warmth, and erythema. Joint fluid analysis in gout typically shows negatively birefringent monosodium urate crystals under polarized light microscopy. However, even in the absence of seeing these crystals, the presence of a leukocyte count in the aspirate of 2000 cells/µL, and often even more than 50,000 cells/µL, can be consistent with gout. While hyperuricemia supports the diagnosis, acute gout can occur even with normal uric acid levels, especially if the patient had received treatment or dietary modification prior to the measurement. The presence of alcohol intake is a known risk factor for gout.