The authors present a case of a 70-year-old female who abruptly developed deep-seated pustule at
both palms and soles. Aspiration content of the papule for gram’s stain revealed needle-shaped materials
with negative birefringence polarized light examination. Histological examination revealed deposition of
amorphous materials surrounded by histiocytes, multinucleated giant cells, and lymphocytes in the dermis,
which is a characteristic of gouty tophi. In conclusion, this is an extremely rare presentation of gouty tophi in
all aspects including onset of presentation, duration after first episode of arthritis, site of involvement, and
peculiar dermatological finding.

Keywords: Arthritis, Gouty, Foot, Hand