Recent observations indicate quite a high incidence of tuberculosis among hemodialysis (HD) patients. Mycobacterium tuberculosis generally causes extrapulmonary infections in such patients. Here, a 51-year-old female HD patient is reported. For the last 20 days, she had fever particularly high at night and back pain. Thus she was hospitalized in the nephrology service and clinical and radiological observations were done. Bone X-ray revealed a bone lesion at L4-5 vertebral level. Biopsy performed under computerized tomography (CT) did not yield a diagnosis. The definitive diagnosis was possible after histopathological and microbiological examination of the material obtained with open surgery. This report is important because spinal tuberculosis is rare among HD patients. In addition, this case merits presentation due to the high mortality rate of tuberculosis in HD patients.