Gout on great toe

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Gout on great toe

mdiv
Family Medicine

46 y.o. T2DM male with hx of gout c/o 1 month history of swollen, erythematous and painful left great toe. Blunt injury to toe 2 wks before onset of symptoms. Presented 3 wks in c/o chills, pain to toe, no fever. Treated with 5d indomethacin, 10d of clindamycin. Slight improvement in redness and swelling, pain completely resolved. Xray sugg gout, rheum panel showed elevated crp and esr, anti-dna slightly up at 7, wbc 11.7, rest fine. Swab grew staph. Area now has some open area, fluctuant but not painful/oozing. Suggestions on next steps??? Rheum/ ortho referral?

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