Tuberculosis in infants although less common compared to older children and adults, is associated with a high risk for milliary tuberculosis, tuberculosis meningitis and overall higher mortality. Lung abscess commonly presents following severe community acquired bacterial infections and is extremely rare in infants with tuberculosis. This report presents the case of a 10-month-old infant who had an unusual presentation of pulmonary tuberculosis with no cough, poor growth or documented temperature >38 C despite extensive right lung involvement with lung abscess formation and pleural effusions. Inflammatory markers were minimally deranged. The diagnosis of pulmonary tuberculosis was confirmed based on positive tuberculosis polymerase chain reaction test. The child made a successful clinical and radiological recovery upon completion of anti-tuberculosis drug regimen for six months. This report brings to light that it is crucial for clinicians to have a high index of suspicion of tuberculosis irrespective of age of the patient, presenting symptoms and low prevalence since delayed diagnosis of tuberculosis in infants is associated with poor outcomes.