A 45 year old man presents with excruciating pain, redness and swelling of his right big toe. There is no history of trauma. His medical history is unremarkable, and he is not on any drugs. He smokes 1 to 2 cigarettes each day and drinks around 10 to 12 units of alcohol each week.
WBC: 16,000/mm3 (4,000-11,000) Hb: 13.4 mg/dl Platelets: 256,000/mm3 (150,000-400,000)
Serum Uric Acid: 7.4 mg/dl (<6.8 mg/dl)
Appearance: clear WBC: 2300/uL, with a predominance of polymorphonuclear leukocytes Polarized light microscopy: Uric acid crystals are seen Microscopy: no abnormalities Gram stain: negative Culture results will be available in 3 days
Urea: 5.5 mmol/L (2.5-6.7) Creatinine: 1 mg/dl (0.8-1.4)