A 23-year-old Portuguese man, smoker, HIV negative, with recent multidrug-resistant tuberculosis (MDR-TB) contact, presented with acute lower back pain with radiation to the right flank. There were no respiratory, constitutional, or neurological symptoms. Abdominal computerized tomography (TC) showed a retroperitoneal perirenal abscess. Empiric antibiotic treatment and surgical drainage were performed. After 4 months of persistent symptoms, a MRI of the spine was done, which showed instability of the spine due to total lytic bone destruction of T11 and T12 vertebral bodies, focal lytic lesions at bodies T5-T10 bodies, perivertebral abscesses, and also a psoas abscess. A percutaneous biopsy revealed MT (AFB and culture positive). Molecular testing for drug resistance was positive to isoniazid and rifampicin. No other resistance was observed in culture with drug sensibility tests. Other organ involvement was excluded. Surgical stabilization with an autograph reconstruction of T11 and T12 was performed. The patient started an anti-MDR TB therapy with pyrazinamide, ethambutol, amikacin, levofloxacin, ethionamide, and cycloserine. He finished treatment after two years. He has now a moderate chronic back pain and vertebral body loss although with no kyphotic deformity.