As Canada experiences and prepares for notable increases in immigration, health care professionals need to be aware of emerging cases of low incidence diseases, particularly when found in higher rates in the foreign-born population. Therefore, we report the case of a 20-year-old male immigrant presenting to a Canadian emergency department with a one year history of worsening back pain. In the emergency department, thoracic radiographs showed pathologic fractures at T10 and T11 with destructive changes from T8 to T12. Further, a computed tomography scan identified a large paravertebral abscess from T6 to L1, with osseous destruction and spinal stenosis. Magnetic resonance imaging showed bony deformity, epidural, pre- and paravertebral, and bilateral psoas abscesses, and a right-sided pleural effusion. Diagnosis was confirmed with direct molecular testing and treatment was initiated in a timely and efficacious manner. This case report highlights the need for health care providers to have a high index of suspicion and consideration of atypical presentations of low incidence diseases, particularly within the burgeoning immigrant population, to ensure quality health care services are delivered.