Blister as the initial presentation of gout

We present a case of gout that presented initially as a bullous lesion. The patient had no history of gout, and the lesion was diagnosed initially as a simple pressure sore. Examination revealed a large blister over the right medial first metatarsophalangeal joint. Aspiration of the blister yielded cloudy fluid, with many monosodium urate crystals present on microscopic examination. There is scant literature on bullous lesions in gout. Such lesions can occur in patients known to have gout or can lead to the diagnosis of gout in previously undiagnosed patients. Gouty blisters likely form at sites of trauma, as has been proposed for gouty tophi. This case also emphasizes the importance of careful clinical and microscopic examination of aspirated fluid for crystals in the diagnosis of gout.