A 3-year-old girl, human immunodeficiency virus negative, presented with weight loss, acute onset of back pain in the lumbar region and refusal to walk. Chest radiograph findings were suggestive of pulmonary tuberculosis. Sagittal T2-weighted magnetic resonance imaging of the spine demonstrates near-complete destruction of the L2 vertebral body with gibbus formation at this site and T2W hyperintense subligamentous abscess (solid white arrow) extending from levels L1 to L3, with compounded compression of the conus medullaris and cauda equina nerve roots (white arrow with dotted line). Tuberculosis was confirmed on tissue GeneXpert.