Spinal Tuberculosis (STB) is much rarer than pulmonary tuberculosis. It can cause neurological and orthopedic problems due to infiltration of vertebrae. Here we report a 27-year-old male patient who applied with cough and low back pain. The chest Xray was unremarkable. In thorax computer tomography there were consolidations at the left and right upper lobes, multiple lytic lesions in the spine, spinal cord compression and gibbous deformity in the thoracic vertebrae. The acid resistant bacteria (ARB) smear and Mycobacterium tuberculosis (MT) culture of bronchial lavage fluid were found to be negative. Due to appearing to be an epidural abscess in thoraco-lumbar magnetic resonance imaging (MRI), surgical drainage was performed. For lytic lesions on the spine, bone biopsy was performed. ARB smear of bone biopsies was positive and MT isolated in the Lowenstein-Jensen culture. The cytology of the biopsy showed necrotizing granulomatous inflammation. Back pain decreased with anti tuberculosis treatment and surgical stabilization. We emphasize that, STB, in MT endemic and other developing areas, is an important consideration the differential diagnosis of patients presenting with low back pain.