A 31-year-old HIV-negative man presented to our clinic with a 6-month history of back pain and a swelling at the back. Radiological studies revealed lumbar vertebral destruction. Ultrasound of the mass showed a septated cystic mass with turbid fluid. Diagnostic aspiration revealed thick pus and smear microscopy detected acid-fast bacilli. Xpert MTB/RIF assay detected Mycobacterium tuberculosis with no rifampicin resistance.