A 41-year-old Australian man with a history of gout presented with severe thoracic back pain and fevers, causing him to be bed-bound for a week. There was no infectious or traumatic precipitating event. This magnetic resonance image of the spine showed a lytic lesion on the T1 spinous process with inflammatory changes in the adjacent soft tissues and surrounded by a small collection of fluid. There was no spinal cord involvement.
The patient was treated for vertebral osteomyelitis and gout until a spinal aspirate showed monosodium urate crystals. He made a full recovery.