Figure 1 Quiz of the Week

A 70-year-old male with a history of hypertension presents with a fever and severe pain in both his hands. Examination reveals swollen, erythematous, and tender nodules on the joints of his fingers. Arthrocentesis demonstrates negatively birefringent urate crystals in the synovial fluid. 

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Image credit: @drugpiter, @twcc.

Answer: Precocious puberty

This patient’s clinical presentation and synovial fluid findings suggest he is experiencing an acute attack of gout. Many factors can promote an attack of gout — including drugs, surgery, trauma, and diet. Thiazide or loop diuretics and low-dose aspirin are among the list of drugs that raise serum urate concentrations. Hypertensive patients with gout who are currently on these therapies may need to consider alternative management.

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