Introduction: Intramedullary spinal tuberculoma (IMT) combined with abscess is rare. Because of such rarity, there is no standardized treatment protocol for this condition. We present a case of intramedullary tuberculoma combined with abscess in a female child who was successfully treated with surgery and antituberculosis medicine. Case report: We present a case of spinal intramedullary tuberculoma in a 2-year-old female child who was receiving antituberculous treatment for tuberculous meningitis presented with weakness in both lower limbs. Magnetic resonance imaging (MRI) lumbar spine showed heterogeneously enhancing intramedullary lesion in the lumbosacral region which was hypointense on T1-weighted images and hyperintense on T2-weighted imaging. Lesion was explored in view of neurological deficit. Pus containing solid lesion was removed. Histopathology confirmed intramedullary tuberculoma with abscess. Conclusion: Intramedullary tuberculoma with abscess is a rare cause of paraparesis. In spite of antituberculous treatment, patients are susceptible for development of intramedullary tuberculoma with abscess. One has to keep this pathology in mind when patients present with intramedullary space occupying lesions with tuberculous lesions elsewhere.