Introduction: Spinal tuberculosis TB represents 1% of all TB cases and 50 - 60 of osteoarticular TB cases.¹ Certain atypical clinical and radiological presentations of spinal tuberculosis are described infrequently. ² The lack of recognition of these presentations can lead to a delay in diagnosis and in the initiation of treatment. ³ We present the case of a patient with atypical vertebral tuberculosis operated on in our hospital.

Clinical case: A 56-year-old male with a history of diabetes mellitus no history of tuberculosis contact with a 3-year history of moderate low back pain without sciatic pain that did not improve with physical therapy The general and systemic physical examination was normal The tests showed PCR 9.8 ESR 24 BK in sputum brucellosis test and ELISA and chest X-ray were normal. A tomography and magnetic resonance imaging of the lumbosacral spine showed an osteolytic lesion involving L2 L3, isointense on T1 with regular punched-out borders sparing the L2 L3 intervertebral disc suggestive of vertebral tuberculosis He received standard tuberculosis treatment for 24 months with no improvement A new open biopsy revealed Mycobacterium tuberculosis GenXpert.

Conclusion: Spinal tuberculosis continues to be a global health problem Diagnosing atypical spinal tuberculosis remains difficult which could lead to inappropriate treatment especially regarding the choice of treatment regimens and surgical options Histopathological confirmation is essential for time management