Endocrine Case Report: One Month of Joint Pain

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This endocrine case report from Brady Pregerson, MD, features a man in his 50s with bilateral ankle and foot pain/swelling. Can you determine the correct diagnosis?

Case History:

A man in his early 50’s with no known prior medical history presents to the emergency department for one month of bilateral ankle and foot pain/swelling that recently has started to involve his right knee. He says he’s never had anything like this before and the pain is constant but worse when he walks.The pain has been at the same severity since the day after it started and he finally came in because it wasn’t getting better and family members were pressuring him to see a doctor.He denies any injury or drug use and denies any fever or other complaints. He denies any family history of arthritis or other rheumatologic conditions.

Vital Signs & Physical Exam:

Vital signs are normal except for a temperature of 99.8. The physical exam is notable for bilateral foot swelling, which is somewhat impressive (see image below), plus, to a lesser degree, right knee swelling. A small knee effusion was appreciated in full flexion. Otherwise the exam is normal.

Initial Diagnostic Testing:

Blood: WBC slightly elevated at 11.6 and hemoglobin slightly low at 11.8. CRP about 30 times normal at 30 and ESR >140. Uric acid was normal

Imaging: Knee and ankle x-rays were read as negative with no erosions or effusions

What is the most likely diagnosis?