A 40-year-old man to the physician because of severe pain and swelling in both knees for the past day. He has a history of end-stage renal disease for which he underwent a renal transplant 10 weeks ago. The patient takes an immunosuppressive regimen that includes cyclosporine and low-dose prednisone His temperature is 37.4°C (99.4°F). serum creatinine level is within normal range with no proteinuria. Physical examination shows swelling and erythema of both knees and the base of his left big toe. . Microscopic examination of joint fluid from the knee shows numerous neutrophils as well as both intra- and extracellular crystals as shown in the exhibit.
Which of the following mechanisms is most likely responsible for this patient's acute symptoms?

Question

A 40-year-old man to the physician because of severe pain and swelling in both knees for the past day. He has a history of end-stage renal disease for which he underwent a renal transplant 10 weeks ago. The patient takes an immunosuppressive regimen that includes cyclosporine and low-dose prednisone His temperature is 37.4°C (99.4°F). serum creatinine level is within normal range with no proteinuria. Physical examination shows swelling and erythema of both knees and the base of his left big toe. . Microscopic examination of joint fluid from the knee shows numerous neutrophils as well as both intra- and extracellular crystals as shown in the exhibit. 
Which of the following mechanisms is most likely responsible for this patient's acute symptoms?

Quizplus · Accepted Answer

Eductional Objective: In the patient with a kidney transplant and takes immunosuppression has a risk to develop a gout arthritis due to medications that impair renal clearance of uric acid. Cyclosporine has a side effect that increase risk of gout due to decreased uric acid excretion.

A 40-Year-Old Man to the Physician Because of Severe Pain