Common sites of monosodium urate (MSU) deposition include the first metatarsophalangeal joint, ears, fingers, and olecranon bursa.1 The nose is an unusual location for gout. A 62-year-old male individual presented to the emergency department with acute bilateral hand pain. He has a background of untreated chronic tophaceous gout, type 2 diabetes mellitus, ischemic heart disease, and hypertension. He did not tolerate allopurinol in the past due to development of a rash.
