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 wi th a history of gout, who was receiving chronic immunosuppressive therapy a fter a renal transplant and who presented with fever and back pain. After a n extensive work-up and biopsy, the diagnosis was thoracic tophaceous gout. The pain and fever responded to prednisone and allopurinol. Tophaceous gou t is a rare cause of fever and back pain but should be considered in the di fferential diagnosis in the appropriate clinical setting.