A 72-year-old man was admitted to our hospital because of worsening polyarticular swelling pain. An 18F-FDG PET/CT was performed to evaluate the extent of a suspected gouty attack and to exclude any unexpected malignancy. The images showed multiple juxta-articular and subcutaneous foci of elevated 18F-FDG activity in both upper and lower extremities, including the hands, elbows, shoulders, hips, knees, ankles, and feet. Diagnosis of an acute, severe gouty attack was eventually made. The patient responded well to antigouty therapy.