Gout is an inflammatory disease characterized by hyperuricemia and monosodium urate crystal deposits, typically affecting peripheral joints at the extremities. We present an atypical case of the disease developing in the fingertip of a 56-year-old Middle Eastern female with a complex history of breast cancer, congestive heart failure, dilated cardiomyopathy, and left arm and hand lymphedema. After months of painful swelling and limited flexion in the left distal index finger, the lesion was initially diagnosed by her primary care provider as an abscess. The persistence of symptoms despite antibiotic treatment prompted further investigation. The patient received an excisional biopsy with histopathological examination, which revealed needle-like amphophilic crystals in the dermis accompanied by foreign body-type giant cells and histiocytes. These results, alongside elevated uric acid levels, confirmed the atypical presentation of tophaceous gout in the left index fingertip. The introduction of 300 mg daily of allopurinol significantly improved symptoms, decreasing joint pain, and the left fingertip lesion resolving. This unusual presentation of gout is secondary to a comprehensive breast cancer medication regimen and lymphedema of the left arm and hand, potentially resulting in the deposition of uric acid in this uncommon location. This unusual presentation of gout underscores the importance of considering gout in differential diagnoses, even in atypical locations.