A 50-year-old male presented to the emergency department for left lower limb pain of one-day duration. He recently underwent right-sided total knee replacement (TKR) three weeks ago which was complicated by left lower limb deep venous thrombosis (DVT) requiring coumadin therapy. At presentation, the pain was severe enough to compromise his ambulation. The initial concern of the proximal progression of his DVT was considered less likely, as a review of his electronic medical records suggested that he was anticoagulated adequately with a target international normalized ratio being maintained between 2 and 3.
Image attached shows: A: Swelling of the left ankle. B: X-ray ankle joint showing soft tissue swelling C and D: Direct microscopy showing rhomboid-shaped crystals confirmed by polarized light. On examination: Swelling, erythema over ankle joint which was extremely tender to touch No…
