A 64-year- old male presents to the ED with 24 hours of severe left ankle pain. The patient noticed the pain upon awakening the day before AM. It rapidly became so severe he could not bear weight on it. He denied trauma and has never had similar pain in the past in this or any other joint. On ROS he had noted a low-grade fever for 1 day. Past History: HTN, CAD, CHF, Type II diabetes The patient had a small pustule on his left toe, which he treated himself with warm compresses, resolving with resolution.
Past medication history: ASA, glyceride, lisinopril, digoxin, furosemide, isosorbide dinitrate PE: Left ankle is very swollen, red and tender. Passive and active motions are markedly limited by pain. He has a 5 mm shallow ulcer over the left 5th toe with minimal surrounding erythema. There is no edema. He has normal sensation in his feet. Heart, lung, and abdominal exams are…
