The authors present a case of a 70-year-old female who abruptly developed deep-seated pustule at both palms and soles. Aspiration content of the papule for gram's stain revealed needle-shaped materials with negative birefringence polarized light examination. Histological examination revealed deposition of amorphous materials surrounded by histiocytes, multinucleated giant cells, and lymphocytes in the dermis, which is a characteristic of gouty tophi. In conclusion, this is an extremely rare presentation of gouty tophi in all aspects including onset of presentation, duration after first episode of arthritis, site of involvement, and peculiar dermatological finding