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A 57-year-old man presented with a three-month history of cream-yellow papules of 2 to 3 mm on the pulps of his fingers on both hands (Panel A) and on his right elbow (Panel B). Ten months earlier he had undergone bilateral lung transplantation and had since been receiving multiple medications, including cyclosporine and furosemide. The serum uric acid level was 10.2 mg per deciliter (607 µmol per liter). A lesion was scraped with a scalpel with a 15 blade and smeared onto a glass slide. Polarizing microscopy revealed multiple needle-shaped crystals that were bright yellow (Panel C) and were not birefringent. Films of both hands showed soft-tissue swelling and erosive bony changes in the wrists and interphalangeal joints. Treatment with colchicine and allopurinol was started. Three months later, there had been minimal improvement.
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A correction has been published: N Engl J Med 2002;347(11):862.
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