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Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis complex. It is a major public health problem, and one of the world's leading causes of morbidity and mortality. It occurs in both pulmonary and extra-pulmonary forms, the pulmonary form being the most common. Primary iliac bone tuberculosis remains a rare clinical entity, even in endemic areas. Its diagnosis can be challenging due to its similarity to other bone conditions. We report a rare case of primary iliac bone tuberculosis in a 63-year-old patient on peritoneal dialysis, with the following medical history: hypertension, type II diabetes complicated by diabetic retinopathy and diabetic kidney disease. Recent advances in molecular biology, in particular with the advent of the Genexpert®, have considerably improved patient management, providing microbiological evidence in less than two hours.