A 40-year-old male presents with acute onset of excruciating pain, swelling, redness, and tenderness in his left great toe. He denies any recent trauma. He reports consuming a large amount of seafood and alcohol at a party the previous night. Physical examination reveals an exquisitely tender, warm, and erythematous metatarsophalangeal joint of the left great toe. What is the most likely diagnosis?

Why the other options are wrong

• A. Pseudogout (calcium pyrophosphate deposition disease) also causes acute monoarthritis, but typically affects larger joints (knee, wrist) and is less common in the great toe. It's also more common in older patients.
• B. Septic arthritis presents with similar joint inflammation but would likely involve fever, chills, and require a history of recent infection or penetrating trauma, which are not present here. It's a diagnosis of exclusion here.
• D. Cellulitis typically presents with poorly demarcated erythema and warmth, often with fever, but less localized to a joint and usually not as exquisitely tender as gout. It wouldn't be triggered by diet.