Tumor necrosis factor (TNF)-α inhibitors increase the risk of reactivation of latent tuberculosis infection (LTBI). Nowadays it is universally accepted the importance of screening and prophylaxis for LTBI. We present a case of tuberculous spondylodiscitis in a man with Crohn’s disease (CD) with a negative tuberculin skin test (TST) and no evidence of active chest disease. It is important to suspect tuberculosis even in patients with a negative screening or in patients who received prophylaxis, in fact, it is well described both the possibility of false negatives screening tests and failures of prophylaxis in this setting of patients.