Five patients were treated at the Queens Hospital Center between 1987 and 1989 for tuberculosis of the spine. All were members of low socioeconomic status minority groups: four were black and one was Asian. Three were intravenous drug abusers and were positive for human immunodeficiency virus (HIV), one was homeless and suffering from alcoholism, and one had just arrived in the United States from a region in Asia endemic for tuberculosis. All three HIV positive patients had negative tuberculin skin test results, had no radiographic signs of pulmonary involvement, and were anemic on presentation; one of them had a bone marrow biopsy that was positive for acid-fast bacilli. Since there may be a prolonged delay without significant radiographic findings, a high index of suspicion is necessary to make the diagnosis of tuberculosis of the spine.