Abstract: Objective:To analyze the diagnosis and treatment methods of one acute gout attack patient with persistent medium and high fever as the first manifestation, and to improve the understanding of the clinicians for acute gout attack with persistent medium and high fever as the first manifestation. Methods:The cliniccal data of an elderly male patient with fever of unknown cause was collected; the literature review was perfomed and the diagnosis and treatment methods of the disease were explored. Results:The patient was admitted to hospital because of persistent fever for 4 d. The count of white blood cells in the routine blood test was high and the left lower lobe inflammation was found in the chest CT scanning. The patient was given the active anti-infection treatment for 10 d,but there was no obvious relief of fever manifestation, and the count of white blood cells remained the high level; no positive results inducing fever were found through comprehensive laboratory examinations and imageological examination. The gout nodules on both feet of the patient were found by physical examination and the level of uric acid was high, so the patient was given experimental anti-gout treatment combined with his previous history of gout. The patient's fever manifestation gradually relieved, the count of white blood cells in routine blood test and the level of uric acid were gradually decreased to the normal levels. The acute gout attack was considered as the cause of fever. Conclusion:For the patients with fever of unknown cause, especially with medium and high fever, if the systematic anti-infection treatment is not effective,the possibility of acute gout attack should be considered.

Key words: gout, fever, gouty arthritis, case report