A patient comes to you with these findings and new onset of left foot pain. What’s your likely diagnosis?
This is a patient with chronic tophaceous gout likely presenting with an acute gout attack of the foot. The enlarged and often inflamed fingers (dactylitis) can be mistaken for psoriatic arthritis and ankylosing spondylitis. Additionally, the finger and elbow involvement could be mistaken for rheumatoid arthritis (RA). However, in gout there is more asymmetry to the joint involvement. Finally, the aspiration of fluid will be positive for uric acid crystal, confirmed the diagnosis of gout.
This patient also had a superinfection of his left elbow tophus that required drainage and antibiotics: