24th February 2025

A 45-year-old woman with previous end-stage renal disease due to SLE, who received a renal transplant five years ago and now only has mild-to-moderate CKD, presents to A&E with a severely painful, erythematous, swollen left ankle.

A 45-year-old woman with previous end-stage renal disease due to SLE, who received a renal transplant five years ago and now only has mild-to-moderate CKD, presents to A&E with a severely painful, erythematous, swollen left ankle. She is compliant with her immunosuppressants, and the Nephrologists are happy with her blood tests, though they did recently start allopurinol after an episode of gout a few months ago, which resolved with colchicine. She was treated for gout with colchicine again a few days ago upon her return from holiday, but it gave no relief, and she is now unable to walk, nor will she let you touch the joint, which looks erythematous and swollen. She is febrile, with a borderline tachycardia and hypotension. What is the first point of management once a sample has been aspirated from the joint?

Select the SINGLE most appropriate option from the list below. Select ONE option only.