Chronic Tophaceous Gout

A 44 year old man presented with a 15-day history of painful swelling of right middle finger, which was also red, warm, and tender. A tooth paste like, chalky substance was expressible on pressure from the swelling. The patient reported that he had occasional episodes of joint pains involving both small and large joints of the extremities. He denied a history of medication intake and past history of nephrolithiasis.