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Background: Tubercular pyomyositis is a rare entity in immunocompetent induvial, and involvement of head and neck region is very uncommon. It usually presents as diffuse swelling with some tenderness and other constitutional symptoms of tuberculosis (like a low-grade fever, loss of appetite, and weight loss). It can also mimic other entities like a pyogenic abscess, malignancy (sarcoma), benign soft tissue tumors, cervical lymphadenitis, and hematoma; which can pose a diagnostic challenge.

Case description: We here present a case of a 22-year-old male who came with complaints of neck swelling with low-grade fever and weight loss for about a month duration. A detailed clinical history and examination helped us to narrow down the differential. Finally radiological imaging and microbiological test aided in clenching the diagnosis and helping with further management. The patient was diagnosed with tubercular pyomyositis of cervical muscles and was successfully treated with first-line anti-tubercular therapy.