Hyperuricemia and gout are known to occur in patients receiving diuretic therapy. More recently recognized, however, is the occurrence of tophaceous gout in patients treated with cyclosporine. We report a 57-year-old man with normal renal function who was started on cyclosporine immediately after undergoing bilateral lung transplantation. Six months later, he developed progressive renal insufficiency and hypertension. In the following four months (10 months after starting his immunosuppressant medication), he presented with a symmetrical distribution of tophi on his finger pads. Seven previous cases of finger pad tophi have been reported and are reviewed.