Bilateral ankle pain/swelling diagnosed as gout. Responding well to Prednisone. Doubtful of diagnosi

Current meds: Metropolol Succinate XL, Fluoxetine, Amlodipine (Norvasc). Was prescribed Wellbutrin XL on 2.8.2016 and took that up until 3.28.2016 when my prescription was discontinued.

A little over three weeks ago (3.13.2016) I woke up with pain and swelling in my ankles as well as pain in the heels of both feet. After two days of the pain worsening I went to the ER (3.15.2016) where, upon a visual inspection, the doctor diagnosed it as cellulitis and prescribed antibiotics. Two days later, the pain persisted so I visited my family doctor where I was prescribed Prednisone and had blood labs performed (3.17.2016). I took the Prednisone that day and by the next morning I could walk again. The pain and swelling had disappeared completely.

The tests that were performed were:

Uric Acid (6.8 mg/dL)

Lyme (Negative)

Rheumatoid Factor (11 IU/mL)

Sedimentation Rate (42 mm/hour)

Compr Metab Panel

CBC/Diff – with flags for for the following components: (WBC: 11.83 K/uL; MPV: 11.8 fL; SEGS: 76%; LYMPHS: 12%; ABS. SEGS: 8.96 K/uL)

The Prednisone was a tapered 10-day dosage, and on the day of my last dose (3.26.2016) the pain began to return and was even worse than it was before. On 3.28.2016 I went to the ER and was admitted for testing and observation.

While in the hospital (3/28/2016), in addition to ultrasounds for DVT/blood clots (negative), they ran another series of blood labs:

Uric Acid (6.7 mg/dL)

CRP, Low Sensitivity (18 mg/L)

Rheumatoid Factor (11 IU/mL)

Sedimentation Rate (24 mm/hour)

Compr Metab Panel

CBC/Diff – with flags for for the following components: (WBC: 12.25 K/uL; SEGS: 80%; LYMPHS: 10%; ABS. SEGS: 9.76 K/uL)

25-Hydroxy Vitamin D (16 ng/mL)

Complement C3 (185 mg/dL)

Complement C4 (32 mg/dL)

ANA (Negative)

CCP IGG AB (<16 units)

that night they gave me more prednisone and when i woke up the next morning the pain and swelling were gone and i could walk again. they ran another battery of labs that day, with slight changes in the cbc/diff. i was also visited by a rheumatologist who diagnosed the whole thing as gout and gave me a 20-day tapered dosage of prednisone and then discharged me. the results of the labs from the day i was discharged (3.29.2016) were:

hepatitis c antibody (negative)

hep b surface antigen (negative)

cbc/diff – with flags for for the following components: (wbc: 11.90 k/ul; segs: 87%; lymphs: 9%; abs. segs: 10.35 k/ul)

for the first 5 days i was out, i was taking 20mgs of prednisone per day and everything has been fine. the last two days i have been taking 15mgs of prednisone. the problem is that last night i experienced some minor swelling and this morning there is a little swelling as well some pain. my fear is that once i taper off the prednisone the whole thing is going to become awful again and i will spend more time in the er/hospital with no one being able to figure out what is actually wrong with me. what else should i be telling them to test for? what are they missing? can this really only be gout? the doctors i met with all seemed a bit perplexed by the whole thing so the final diagnosis was not exactly reassuring. units)="" that="" night="" they="" gave="" me="" more="" prednisone="" and="" when="" i="" woke="" up="" the="" next="" morning="" the="" pain="" and="" swelling="" were="" gone="" and="" i="" could="" walk="" again.="" they="" ran="" another="" battery="" of="" labs="" that="" day,="" with="" slight="" changes="" in="" the="" cbc/diff.="" i="" was="" also="" visited="" by="" a="" rheumatologist="" who="" diagnosed="" the="" whole="" thing="" as="" gout="" and="" gave="" me="" a="" 20-day="" tapered="" dosage="" of="" prednisone="" and="" then="" discharged="" me.="" the="" results="" of="" the="" labs="" from="" the="" day="" i="" was="" discharged="" (3.29.2016)="" were:="" hepatitis="" c="" antibody="" (negative)="" hep="" b="" surface="" antigen="" (negative)="" cbc/diff="" –="" with="" flags="" for="" for="" the="" following="" components:="" (wbc:="" 11.90="" k/ul;="" segs:="" 87%;="" lymphs:="" 9%;="" abs.="" segs:="" 10.35="" k/ul)="" for="" the="" first="" 5="" days="" i="" was="" out,="" i="" was="" taking="" 20mgs="" of="" prednisone="" per="" day="" and="" everything="" has="" been="" fine.="" the="" last="" two="" days="" i="" have="" been="" taking="" 15mgs="" of="" prednisone.="" the="" problem="" is="" that="" last="" night="" i="" experienced="" some="" minor="" swelling="" and="" this="" morning="" there="" is="" a="" little="" swelling="" as="" well="" some="" pain.="" my="" fear="" is="" that="" once="" i="" taper="" off="" the="" prednisone="" the="" whole="" thing="" is="" going="" to="" become="" awful="" again="" and="" i="" will="" spend="" more="" time="" in="" the="" er/hospital="" with="" no="" one="" being="" able="" to="" figure="" out="" what="" is="" actually="" wrong="" with="" me.="" what="" else="" should="" i="" be="" telling="" them="" to="" test="" for?="" what="" are="" they="" missing?="" can="" this="" really="" only="" be="" gout?="" the="" doctors="" i="" met="" with="" all="" seemed="" a="" bit="" perplexed="" by="" the="" whole="" thing="" so="" the="" final="" diagnosis="" was="" not="" exactly="">

that night they gave me more prednisone and when i woke up the next morning the pain and swelling were gone and i could walk again. they ran another battery of labs that day, with slight changes in the cbc/diff. i was also visited by a rheumatologist who diagnosed the whole thing as gout and gave me a 20-day tapered dosage of prednisone and then discharged me. the results of the labs from the day i was discharged (3.29.2016) were:

hepatitis c antibody (negative)

hep b surface antigen (negative)

cbc/diff – with flags for for the following components: (wbc: 11.90 k/ul; segs: 87%; lymphs: 9%; abs. segs: 10.35 k/ul)

for the first 5 days i was out, i was taking 20mgs of prednisone per day and everything has been fine. the last two days i have been taking 15mgs of prednisone. the problem is that last night i experienced some minor swelling and this morning there is a little swelling as well some pain. my fear is that once i taper off the prednisone the whole thing is going to become awful again and i will spend more time in the er/hospital with no one being able to figure out what is actually wrong with me. what else should i be telling them to test for? what are they missing? can this really only be gout? the doctors i met with all seemed a bit perplexed by the whole thing so the final diagnosis was not exactly reassuring.>

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