We report the second case of Mycobacterium kansasii spondylitis in a 14-year-old Caucasian girl who presented with pain in the thoracolumbar region. There was collapsed T8 and discitis, and a cavitary lesion in new chest CT. Biopsy taken from thoracic lesion T8 with CT guidance which had evidence of osteomyelitis and its smear were negative for acid fast bacilli. Bronchoalveolar lavage (BAL) was performed – PCR was negative for acid fast bacilli. Empirical treatment of tuberculosis started and her symptoms resolved. PCR of thoracic sampling revealed M. kansasii after one month. Two months after treatment of M. kansasii, her thoracolumbar pain resolved and the cavitary lesion of the lung disappeared. In patients who are immunocompromised in the association of cavitary pulmonary lesion and infectious spondylitis, atypical mycobacteria may be on the list of common clinical diagnoses but not in immunocompetent patients such as our patient.