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Tuberculosis remains one of the world's leading causes of morbidity and mortality. It occurs in both pulmonary and extra-pulmonary forms. Primary iliac bone tuberculosis remains a rare clinical entity, even in endemic areas. The diagnosis of the disease can be challenging due to its similarity to other bone diseases. We report a rare case of primary iliac bone tuberculosis in a 63-year-old patient who was on peritoneal dialysis, and had a medical history of hypertension, and type II diabetes, which was complicated by diabetic retinopathy and diabetic kidney disease. Magnetic resonance imaging (MRI) revealed osteomyelitis in the iliac bone, while real-time polymerase chain reaction (PCR) using the GeneXpert® system on a gluteal collection sample confirmed the diagnosis of tuberculosis (TB). The integration of advanced molecular tools, such as GeneXpert®, represents a significant progress, enabling rapid and accurate diagnosis of TB and facilitating early initiation of treatment.