LAUSR

An 89-year-old man was admitted because of fever and right knee pain for 1 day. He had hypertension, diabetes mellitus, chronic renal failure (CRF), ischemic heart disease, osteoporotic vertebral collapse, and left neck of femur fracture with operation performed. On physical examination, he was noted to have fever (38 C) and right knee effusion. In addition, whitish papules or plaques were noted over the finger-pads of bilateral thumbs, right ring finger, left index finger, and bilateral middle fingers; whitish to yellowish nodules were noted over the bilateral index fingers, bilateral middle fingers, and right ring finger (Figure 1). Complete blood count was normal. Renal function test noted elevated urea (42.3 mmol/L) and creatinine (342 mmol/L). Urate level was 611 mmol/L. X-rays of the right knee and bilateral hands were unremarkable. Right knee arthrocentesis was performed and noted urate crystals within the joint fluid. The patient was prescribed colchicine and Panadol. Due to the possibility of pustules, the orthopedic surgeon was consulted. Longitudinal incision was performed over the whitish plaque on the right ring finger reviewing chalky whitish materials. These materials