Early diagnosis of spinal tuberculosis in young children is difficult due to atypical clinical features. We report a case of lumbar tuberculosis with abscess of the psoas major muscle in a 4-year-old child. Spinal reconstruction was challenging due to the involvement of multiple vertebral levels. The child complained of lumbar and back pain. Preoperative magnetic resonance imaging (MRI) revealed bone destruction of the L1-L3 vertebral body and abscess formation of the psoas major muscle. The child underwent excision of the vertebral lesions and a fresh iliac bone graft from his mother through an anterior approach and posterior fixation with T12-L1 and L4-L5 pedicle screws. At the 15-month follow-up, the patient had good clinico-radiologic outcomes with evidence of bony fusion. No functional impairment of lumbar movements was found through physical examination during the follow-up period. The report highlights the diagnostic dilemma of early childhood spinal tuberculosis due to lesions seen both on radiology and during surgery and discusses challenges in management of the disease and the relevant literature. The mother's iliac bone graft we describe can be a viable option in very young children with severe vertebral bone destruction requiring reconstruction by surgical procedure.