Coming to grips with gouty lesions

It had been slowly growing for three months. Several courses of antibiotics had no effect. The area was not tender. Swabs were negative.

Consideration was given to this being a deep fungal infection or calcium deposition but the material exuded was neither pus nor hard calcium.

In fact, these were gouty crystals deposited thickly in the skin without any recent history of acute gout. The patient was on low-dose oral steroids for another problem that may have suppressed inflammation.

An incisional biopsy was done. His uric acid level was twice