A 42-year-old previously asymptomatic healthy male presented to our outpatient department with complaints of diffuse Lower back pain which started 15 days earlier and suddenly increased for the past 2 days. The pain was constant dull aching without diurnal variations, radiating to bilateral lower limbs affecting his daily routine. He gave no other significant contributing history. On physical examination, he was well built and nourished with no gait or postural abnormalities and visible deformities. On palpation, mild tenderness was present over L3, L4, L5 vertebral spinous processes along with adjacent Paraspinal muscle spasms. The neurological status was normal. His blood examination revealed raised erythrocyte sedimentation rate of 84 mm/h. Rest of the blood parameters were normal. Plain radiograph of the lumbosacral spine revealed a mild reduction in the height of the L4 vertebral body with sclerosis [Figure 1]. Magnetic resonance imaging (MRI) of the lumbosacral spine showed heterogeneous signal intensity and fracture of L4 vertebral body with associated epidural and paravertebral abscess collections causing mass effect on Cauda Equina and filum terminale [Figure 2a-d]. Contrast MRI showed homogenous enhancement of the lesion in the L4 body and the canal [Figure 3a-c]. He underwent L3-5 posterior spinal instrumentation with pedicle screws and rods and posterior spinal decompression at stenotic level [Figure 4]. Biopsy samples were obtained from the L4 vertebral body through transpedicular approach and from the intracanalicular tissue. Biopsy samples and fluid collected were subjected to histopathological and microbiological analysis. Intra-operative and immediate postoperative periods were uneventful. Tissue staining and cultures were negative. Polymerase chain reaction (PCR) for tuberculosis (TB) was negative. Histopathological examination of the biopsy material showed bony spicules interspersed with fibro collagenous tissue, marrow elements along with areas of focal congestion and foci of mild chronic inflammation. No evidence of malignancy was traced and immunohistochemistry (IHC) studies were negative. Based on clinical and radiological evidences, impression of tuberculous spondylitis was made since TB is very common in our region though PCR was negative and medical treatment for the same was initiated. The patient was functionally better for 1 month until he developed sudden onset of progressive weakness with no associated sensory disturbances of both the lower extremities. On examination, the power was Grade 1 in bilateral L4, L5, and S1. Bowel and bladder were spared and had normal bilateral lower extremities sensations. MRI of the lumbar spine revealed increase in the soft tissue component compared to the previous report extending from L3 to L5 vertebra causing complete canal stenosis along with pre and para vertebral involvement [Figure 5a-c]. Positron emission tomography (PET) computed tomography revealed increased fluorodeoxyglucose uptake in the L4 body and in the prevertebral, paravertebral regions and in the spinal canal [Figure 6]. He was taken up for revision decompression considering his progressive lower limbs weakness. Intra operatively, we found extensive friable tissue engulfing and surrounding the dura at L4 vertebral level for which extensive debulking was carried out [Figure 7]. The debulked tissue was sent for histopathological and microbiological analysis. Microbiological reports were inconclusive as no organism was isolated. PET scan showed features in favor of infective etiology and no similar lesions elsewhere. According to the histopathology report the biopsy tissue had features in favor of Epitheloid Sarcoma. Microscopic appearance showed neoplastic tissue with infiltration by tumor cells which are round to oval shape with nuclear pleomorphism, irregular nuclear membrane, and moderate cytoplasm. Many cells showed prominent cells with the epithelioid appearance and eosinophilic nuclei with adjacent lymphoid cells [Figure 8]. Subsequently, the tissue was also subjected to IHC in which the tumor cells were positive for Vimentin and Epithelioid Membrane Antigen (EMA), thereby reconfirming the diagnosis of Epithelioid Sarcoma [Figure 9]. Fever was managed with antipyretics and rehabilitative physiotherapy was initiated. Wound healing was good. There was no improvement in the neurological status. Radiotherapy and Chemotherapy were planned but the patient died 4 weeks postoperative due to multiorgan dysfunction.