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Author: Sushil Khadka / Editor: Fiona Mendes / Codes: MuC2, SLO1Published: 08/02/2024

A 63-year-old bank manager presents to the Emergency Department (ED) with a painful swelling of his right great toe. He woke up with severe pain in his right great toe. He has no history of trauma or injury and cannot explain why his toe hurts so much.

He was recently diagnosed with hypertension. He started taking Bendroflumethiazide prescribed by his GP two weeks ago. He smokes about 5-7 cigarettes per day and drinks about 4-5 pints of beer on weekends.

On examination, of note, he is afebrile. His heart rate is 78 beats per minute and his blood pressure is 130/70 mmHg. He has an erythematous and swollen right great toe with underlying tenderness over his first metatarsophalangeal (MTP) joint.