Spinal tuberculosis (STB) accounts for a large proportion of extra-pulmonary tuberculosis. STB usually begins in the peri-discal region of the vertebral bodies and isolated involvement of the posterior elements of the spine is very rare. MDR-TB is a global concern and has been described from patients with spinal tuberculosis as well. MDR - TB in an immunocompetent patient is an extremely rare condition. The authors present a case report of an isolated MDR-TB of a lumbar spinous process in an immunocompetent patient which mimicked an osseous tumour. The diagnosis, both radiological and bacteriological, and management of this rare condition is discussed and the authors stress the need for a high degree of suspicion in its diagnosis and management.
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