Gout of the spine is very rare. Forty-one cases of gout affecting the spine have been reported.To present a patient with tophaceous gout of the lumbar spine mimicking pyogenic discitis.Case report.The medical record, including operative notes, progress notes, discharge summary, clinical notes, radiological study, and pathological studies was reviewed.The patient had acute low back pain and radiculopathy with high spiking fever. Therefore, pyogenic discitis was suspected. However, histological diagnosis revealed tophaceous gout.Tophaceous gout of the spine is very rare. However, when a patient presents with acute back pain and fever, spinal gout should be considered, particularly in a patient with a previous history of hyperuricemia or gout.