A 40-year-old female presented with a history of radiculopathy and claudication in bilateral lower limbs with a claudication distance of 300 mfor 5 months. She gave a history of intermittent back pain, however, that was not her primary complaint. The patient did not have a history of any constitutional symptoms (fever, weight loss, and evening rise of temperature).There is no history of TB. On clinical examination, there was no local rise of temperature, paraspinal muscle spasm, or local tenderness. Lumbar spine X-ray was normal. Magnetic resonance imaging (MRI)(Fig. 1) revealed ligamentum flavum hypertrophy and a degenerative cause for the low back pain was suspected. However, the computed tomography (CT) scan (Fig. 2) picture revealed a lytic lesion in L(lumbar)2 lamina. Hematological investigations revealed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values. The patient was taken up for surgery. Under general anesthesia in prone position, midline posterior approach was taken. Paraspinal muscles were elevated from their posterior attachments. Level was confirmed by fluoroscopy. Lower spinous process of L2 and upper spinous process of L3 vertebra were removed. Inferior laminotomy of L2 vertebra and superior laminotomy of L3 vertebra were done. Intraoperatively, it was found that the ligamentum flavum and the soft tissue mass were adhered to the underlying dura. Adhesiolysis was done and ligamentum flavum along with the soft tissue mass was removed (Fig. 3a). The soft tissue mass was sent for histopathological examination which showed features ofcaseous necrosis (Fig. 3b). The patient was started on four drugsanti-Koch treatment (AKT) (isoniazid, rifampicin, pyrazinamide, and ethambutol) for a period of 3 months and two drugs AKT (isoniazid and rifampicin) for 9 months. Periodic monitoring of the liver enzymes and ESR, CRP was done. There was serial reduction in the ESR and CRP values and the patient improved symptomatically. At present, the patient is asymptomatic with a follow-up period of 2 years.