Tuberculous retropharyngeal abscess, though rare, poses significant diagnostic and therapeutic challenges due to its atypical presentation. We present the case of a 51-year-old male with a history of drug abuse and inhalational burn injury presented with generalized weakness, sensory deficits, and neurological symptoms. Despite initial negative investigations, subsequent MRI and microbiological studies confirmed a rare case of tuberculous retropharyngeal abscess. The patient underwent urgent drainage and anti-tubercular therapy, experiencing complications such as Candida infection that required prolonged hospitalization and multidisciplinary care. This case underscores the importance of considering tuberculosis in differential diagnosis, especially in patients with unusual presentations and predisposing factors. It highlights the need for comprehensive evaluation, early intervention, and multidisciplinary management to prevent complications and improve outcomes. The case serves to raise awareness among clinicians about this uncommon presentation, emphasizing the need for a high index of suspicion in high-risk individuals and the importance of long-term follow-up and adherence to anti-tubercular therapy.

Adnan Abdullah is a Clinical Fellow in Acute Medicine at Queen’s Hospital, London, and holds an MBBS with MRCP (UK) Part I and II. He is currently pursuing an MSc in Medical Education at University College London, reflecting his commitment to advancing both clinical practice and medical teaching. His academic interests include evidence-based medicine, patient safety, and clinical education. He has authored multiple case reports published in peer-reviewed journals and regularly contributes to audits and quality improvement initiatives. He is dedicated to delivering compassionate, patient-centered care and developing innovative approaches to clinical training and service improvement.