The pus stained positive for acid-fast bacilli (Ziehl Neelsen stain) while the Gram stain was negative [Figure 2]. On histopathology, the wall of the abscess composed of necrotizing granulomatous inflammation, suggestive of tuberculous infection; while the dermal sinus examination revealed chronic inflammation and fibrosis. The pus culture was negative. Mycobacterium tuberculosis (MTB) was detected on MTB DNA polymerase chain reaction. The baby responded well to anti-tubercular treatment. A retrospective search for finding out the source of infection proved unsuccessful. The patient was a 4-month-old baby having received Bacillus Calmette-Guerin (BCG) vaccination at birth, with no other focus of tubercular infection elsewhere in the body. The mother with all family members, including the servants were screened for tuberculosis with chest X-ray and three serial early morning sputum examinations, but none tested positive. She was discharged on anti-tubercular treatment and physiotherapy. Follow-up MR scan showed good resolution of the intramedullary abscess.