Perinatal/congenital tuberculosis is a rare entity, even in human immunodeficiency virus (HIV) endemic populations, and is uniformly fatal if untreated. The liver and the lungs are the most commonly involved organs in this variety of tuberculosis and the spine is a rare site. We report the first case of spine tuberculosis with paravertebral abscess in a neonate who was only 3 weeks of age. The imaging studies, namely radiography, sonography, computed tomography (CT)-guided aspiration and magnetic resonance imaging (MRI), facilitated rapid diagnosis and early institution of chemotherapy. We highlight the role of imaging evaluation in the diagnostic armamentarium for tuberculosis of the newborn, as early diagnosis followed by appropriate treatment resulted in an excellent recovery in our patient.