Tuberculous pyomyositis is a rare entity, with nonspecific presentation that often leads to a delay in diagnosis. It is caused by a small aerophilic bacillus organism and spreads by exhaled respiratory droplets from affected individuals. When tuberculous pyomyositis presents as the initial and only manifestation of the disease, there is a diagnostic dilemma. Even with readily available advanced imaging studies, there are no pathognomonic findings indicative of the disease. Early and accurate recognition is essential to avoid additional morbidity, mortality, and public health risk.