Spinal intramedullary tubercular abscess itself is a rare entity. Very few cases have been reported. We report a case of a 4-month-old female with a dermal sinus in lower back since birth, intermittent fever for 2 months, acute onset paraparesis and bowel bladder involvement showing an intramedullary contrast enhancing lesion extending from D11 to S2 level with low lying conus, and a subcutaneous tract in lower back at S2 level extending from skin up to the sacral canal on magnetic resonance imaging of the spine. Drainage of abscess and biopsy revealed tubercular infection on histopathology. The patient made a good recovery with anti-tubercular treatment and physiotherapy. The source of tubercular infection could not be established. The baby had received Bacillus Calmette-Guérin vaccination at birth and the possibility of vaccination associated tubercular infection could not be ruled out.