AIM: Medications used for tuberculosis (TB) treatment are thought to increase uric acid levels and influence the occurrence of gout. The objective of this study was to evaluate the risk of gout in patients with TB. METHODS: We searched the South Korean National Health Claims database for incident cases of TB. After identifying patients diagnosed with gout within 6 months of TB diagnosis, the risk compared to the general population was estimated by calculating the standardized incidence ratios (SIRs). A nested case-control analysis among patients with TB was performed by matching subjects diagnosed with and without gout in a 1:5 ratio to identify the risk factors for gout. RESULTS: Of the 3848 patients with gout, the proportions of males, patients aged ≥ 70 years, and those with a diagnosis within the first 2 months were 70.2%, 33.0%, and 52.8%, respectively. The incidence of gout in patients with TB was significantly higher than in the general population (overall SIR: 1.42, sex-adjusted SIR: 1.32, age-adjusted SIR: 1.04). Conditional logistic regression analysis indicated that hypertension (odd ratio [OR] 1.43, 95% confidence interval (CI) 1.31-1.58), heart failure (OR 1.19, 95% CI 1.01-1.39), chronic kidney disease (OR 2.47, 95% CI 1.99-3.06), and use of pyrazinamide (OR 1.02, 95% CI 1.02-1.02) and ethambutol (OR 1.00, 95% CI 1.00-1.01) were associated with gout. CONCLUSION: The increased risk of gout in patients with TB and the association between comorbidities and TB medications underscore the need for higher clinical awareness in this population.