Over the course of three days, intense pain, redness and swelling of the left fifth toe wrought great havoc to a 67-year-old man [Figure 1]. There was no antecedent trauma, insect bite, nor change in medication. He denied fever, chills or walking barefoot. He had known hypertension and vitamin D deficiency. As a child, he was diagnosed with psoriasis; skin lesions intermittently recurred into adulthood. Both his parents had gout and a grandfather had psoriasis.
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