Abstract : Sacral tuberculosis is extremely rare musculoskeletal manifestation of spinal tuberculosis (TB) with only a few reported cases in available literature. Sacral area is mostly involved in spondyloarthropathies and certain malignancies, and the features of sacral tuberculosis may often mimic malignancy. Our case is aimed at expanding the knowledge on sacral tuberculosis. We present a case of 29 year old male patient who presented with complains of chronic backache and recent onset neurological deficit. A detailed laboratory and imaging workup of the patient was done. Magnetic resonance imaging(MRI) was employed as primary imaging modality which revealed a heterogeneously enhancing mass lesion in sacral region with associated extension into soft tissues.