A 45-year old Caucasian women was diagnosed with tuberculous spondylitis and paraspinal abscess. M.tuberculosis could be isolated from intraoperativ biopsy; resistance testing revealed a completely sensitive strain. On July 2, treatment was started with rifampicin (RIF) 600 mg/day, Isoniazid (INH) 300 mg/day, Pyrazinamid (PZA) 1500 mg/day and Ethambutol (ETB) 1200 mg/day. After results of the resistance test where available, Ethambutol was stopped. Liver enzymes where elevated at one occasion but fell into normal range spontaneously. After two month of combination therapy RIF/INH/PZA, PZA was stopped according to international guidelines. Four month after begin of treatment, liver enzymes rose again, and INH was replaced by moxifloxacin. Liver enzymes fell to normal level, but the disturbed liver enzymes where later interpreted as alcohol induced. December 12, progression of the paraspinal abscess was diagnosed, and the treatment was stopped for allowing new biopsies. On January 5, 2010, the patient was re-operated but mycobacteria couldn't be cultured in this second biopsy. Antimycobacterial treatment was reinstalled January 7. Because of possible non-compliance, we started again with a four drug combination for one month, followed by INH/RIF/PZA. The patient then did not come to the visits until April 12. At that time the patient complaint about shortness of breath NYHA 2. Haemoglobin level had fallen to 47 gram/L with a mean cell volume of 96 fl and a mean cell haemoglobin concentration of 334 g/L. PZA was stopped, but the other treatment was not changed. Two packs of red blood cells where transfused the day after. One week later, haemoglobin level had risen only to 51 gram/L. Bone marrow aspiration and biopsy was performed on April 20 (under Isoniazid-treatment). Isoniazid was substituted by moxifloxacin, rifampicin was not changed. Again two packs of red cell where transfused. Haemoglobin level rose to 89 gram/L, and reticulocyte production index rose from 0.48 to 2.9 one week after cessation of Isoniazid. No further transfusions where needed, and one week later, haemoglobin level was at 100 gram/L (Figure 1). Folic acid, Cobalamine and Ferritin values where in normal range, Parvovirus B19 PCR was negative. Bone marrow was not typical for PRCA, as it showed an enhanced, dysplastic erythropoiesis with 30% ringsideroblasts (Figures 2 and 3). No rearrangement of the MLL gene could be observed by fluorescent in situ hybridisation (FISH). Erythrocyte count in peripheral blood was 1.5 G/L. Erythropoietin level was high, 1171 IU/L (normal range 12-23) and erythropoietin antibodies negative. Under treatment with rifampicin/moxifloxacin, haemoglobin levels returned to normal level and remained stable.