Q: 62 year old male was admitted to ICU for urosepsis. Patient is recovering from sepsis. Patient c/o pain on his right great toe in the morning and resident diagnosed it with acute gout. Clinical exam shows painful and inflamed joint. Laboratory confirmed hyperurecemia. Patient  has never been treated previously for gout and is not taking any medicine on chronic basis. what would be your next step?



Answer: Rule out septic arthritis

Patient with recent sepsis should be ruled out for septic arthritis particularly in view of no previous history, Hyperurecemia may be an accidental finding. Septic arthritis may clinically looks like gout or pseudogout on exam. If un-treated septic arthritis may become life threatening. Gold standard to distinguish between septic arthritis and crystal-induced arthritis is via examination of joint fluid.