METHODS Case report. OBJECTIVE To present the case of a patient with low back and lower extremity pain suspected to result from lumbar radiculopathy but who was discovered to have symptomatic uterine fibroid (UF). BACKGROUND UFs are usually asymptomatic but at times can produce symptoms such as excessive menstrual bleeding, intermenstrual bleeding, dysmenorrhea, pelvic pain, pelvic pressure, bloating, dyspareunia, urinary and bowel disturbance, subfertility, and pregnancy-related complications. In rare cases, they can cause neural impingement leading to lower extremity pain, which can be mistaken for lumbar radiculopathy. METHODS The patient was a 44-year-old woman who presented with low back pain and left leg pain. Examination suggested lumbar radiculopathy but lumbar magnetic resonance imaging was negative with the exception of a large mass in the pelvis. Pelvic magnetic resonance imaging confirmed this to be a large UF. RESULTS The patient's symptoms completely resolved following hysterectomy. CONCLUSIONS In a female patient with suspected radiculopathy, in whom lumbar imaging is negative, or who does not respond as expected to treatment, UF should be considered.