Whitish bullae on the fingers: what is the diagnosis? Tophaceous gout.

A 56-year-old woman presented with a 6 month history of bullae and whitish plaques of the fingers. She had chronic renal failure, but no joint pains or evidence of arthritis. An aspirate of fluid from a bulla revealed uric acid crystals and serum uric acid was elevated at 16.2 mg/dL. A diagnosis of tophaceous gout was made.