Musculoskeletal tuberculosis represents 1% of total tuberculosis cases. It affects young adults from endemic countries or immunocompromised patients, and may lead to severe functional impairment. We report a case of a 27-year-old male from an endemic country presenting with a 4-month history of fever, a major pectoralis abscess, and low back pain. A lumbar spine MRI revealed osteolytic lesions in multiple vertebral bodies along with a large iliopsoas abscess. Both abscesses were drained and the diagnosis was established by positive polymerase chain reaction assay for tuberculosis. The patient was initiated on anti-tuberculous treatment for 9 months. Musculoskeletal tuberculosis is rarely found in Western countries. If left untreated, it can lead to severe complications which may require surgical intervention.