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Pott's disease, or spinal tuberculosis, is caused by the pathogen Mycobacterium tuberculosis. Although tuberculosis is endemic in developing countries, such as Dominican Republic, Pott's disease is rarely seen, only representing 1% of the total cases. Due to its low incidence, this could be easily misdiagnosed. We report a case of a 17-year-old male with a history of pleural effusion that presented with severe back pain. Several imaging studies reported an aggressive paravertebral neoplasia at the thoracic levels. A surgical biopsy was performed, and the procedure revealed bone fragmentation, which prompted the need to rule out Pott's disease per current recommendations. Biopsy and subsequent positive QuantiFERON-TB Gold test confirmed spinal tuberculosis., Competing Interests: The authors have declared that no competing interests exist.