A 34-year-old man from Ethiopia had been suffering from inflammatory lower backpain for five months. The imaging showed multiple osteolytic lesions histologically corresponding to a granulomatous inflammation. Detection of multiresistant Mycobacteria Tuberculosis (MDR-TB) was delayed because of initially negative microbiological findings. During the therapy of MDR-TB, the patient developed different side effects. In this article we focus on the challenge to diagnose and treat MDR-TB also in a resource-rich setting as it is the case for Switzerland.