A 56-year-old man comes to the physician because of a 1-day history of sudden severe pain in his right great toe. Four months ago, he had an episode of severe joint pain involving his left knee that lasted several days and resolved with over-the-counter analgesics. He has a history of nephrolithiasis and hypertension treated with hydrochlorothiazide. Examination shows erythema, swelling, warmth, and tenderness of the right metatarsophalangeal joint; range of movement is limited by pain. His serum uric acid is 12 mg/dL. Arthrocentesis yields cloudy fluid with a leukocyte count of 18,500/mm3 (80% segmented neutrophils). Polarized light microscopy of the synovial fluid is shown. Which of the following drugs is most likely to have precipitated this patient's condition?

Question

Quizplus · Accepted Answer

Eductional Objective: Gout occurs in the setting of hyperuricemia and causes an inflammatory arthritis characterized by negative birefringent, needle-shaped crystals visible on joint fluid microscopy.  Most diuretics (eg, hydrochlorothiazide, furosemide) can cause hyperuricemia and trigger gout flares by causing relative volume depletion, which decreases the fractional excretion of uric acid.

A 56-Year-Old Man Comes to the Physician Because of a 1-Day