Tophaceous Gout of the Thoracic Spine Presenting as Back Pain and Fever

Spinal gout has been reported only rarely. We describe a 59-year-old man with a history of gout, who was receiving chronic immunosuppressive therapy after a renal transplant and who presented with fever and back pain. After an extensive work-up and biopsy, the diagnosis was thoracic tophaceous gout. The pain and fever responded to prednisone and allopurinol. Tophaceous gout is a rare cause of fever and back pain but should be considered in the differential diagnosis in the appropriate clinical setting.