Case Presentation: A 69-year-old man with hyperlipidemia and hypertension has had 2 episodes of classic podagra per year for the past 3 years. In the past, he developed a rash and nausea after taking allopurinol. He has no history of nephrolithiasis and does not drink alcohol.
He has a mild peripheral neuropathy (idiopathic) and diarrhea-predominant irritable bowel syndrome. Through diet and exercise, he lost 13.6 kg (30 lbs) a couple of years ago, but his weight has since stabilized. Medications Gemfibrozil, 600 mg twice daily Atenolol, 50 mg once daily Lisinopril, 10 mg once daily Examination Findings Body mass index, 26 kg/m2 Blood pressure, 130/70 mm Hg Pulse, 60 beats/min and regular A small tophus on the distal interphalangeal joint of his right index finger Otherwise unremarkable Laboratory Results Complete blood cell count (CBC), normal Aspartate aminotransferase (AST), normal…
