The challenge in management of chronic retro-pharyngeal abscess lies in its proximity to vascular and neurological structures, the access to the abscess should be possible after evaluation of neurological stability and integrity of vascular structures. Tuberculous chronic retro-pharyngeal abscess is an unusual situation. And due to its scarcity, it is not considered in differential diagnosis which delays its management: this could lead to permanent neurological deficit and higher rates of mortality. This the case of a young 29-year-old male, already undergoing anti-tuberculosis treatment for 2 months for a tuberculous lymphatitis, and no history of immuno-suppression, presenting with a large retropharyngeal abscess, with no neurological symptoms or any other specific symptoms. The management of this disease can be simple provided the diagnosis is not delayed, the patient had no complications, and the follow up is performed by a team: otolaryngologist, a neurosurgeon and a phthisiology specialist.<p> </p>