SUMMARY A 44-years old male patient from Egypt, current smoker, with past medical history of active tuberculosis, was admitted complaining of fatigue, malaise and back pain (in vertebral column). The above symptoms started two years ago, when the patient was admitted and treated with anti-tuberculosis treatment, consisting of INH and RIF. The final diagnosis was active pulmonary tuberculosis, associated with spondylitis of the lower thoracic and upper lumbar vertebral column, a conclusion that was supported by clinical and laboratory work-up. A part of the diagnosis was a "cold" abscess extending from L1 to L4 vertebral body. Although the vertebral column tuberculosis is supposed to be the commonest extrapulmonary manifestation of the disease, nowadays, after monitoring correctly its treatment and following the bacilli sensitivity results, it has become rare, though strongly influencing patient's recovery and rehabilitation. Regarding the above case, the tuberculosis mycobacterium was resistant to INH and RIF. Pneumon 1999, 12 (1): 52-56