A postnatal 24 year old postnatal female presented to the emergency department with low grade fever, fatigue and backpain. Investigations revealed Sickle cell disease with haemoglobin of 5 g/dL and decreased hematocrit (29%). Haemoglobin electrophoresis showed Hb F- 38.3%, Hb S- 61.2% and Hb A2- 0.5%. White cell count was elevated and peripheral blood smear demonstrated target cells but no sickle shaped erythrocytes. Radiograph of the dorso-lumbar spine showed diffuse ill defined mixed lytic-sclerotic lesions in vertebral bodies and destruction around the end plates. Computed tomography confirmed the same. Magnetic Resonance Imaging (MRI) demonstrated extensive but patchy and geographic pattern of signal abnormalities in the dorsal and lumbar vertebrae, heterogeneous on T1 and T2 weighted imaging.