We report the case of a 69-year-old male who presented with acute bilateral ankle pain treated as acute gouty arthritis but resistant to colchicine and NSAIDs. In view of very high inflammatory parameters, septic arthritis was initially suspected but ruled out by joint aspiration; the final diagnosis was gouty arthritis. He finally responded well to a short course of oral prednisone. We found this case interesting in view of the initial differential diagnosis and association with a low-carb diet, known to be associated with many metabolic complications among which gout is frequent. [Authors]