Gouty tophi

QUESTION 37

A 47-year-old African American man presents to the dermatology clinic with a hard, painful lesion on the right ear. His medical history is notable for hypertension, hyperlipidemia, diabetes mellitus type II, gout and chronic renal insufficiency. He reports that the area on the right ear has been present for several months and when he manipulated it, he was able to express thick white fluid from it. On examination, there is a smooth white papule on the right antihelix with surrounding erythema, which is tender to the touch (37).