Disseminated tuberculosis (TB) is primarily associated with immunocompromised states, yet it may occasionally present in immunocompetent individuals, posing diagnostic challenges. We report the case of a 28-year-old immunocompetent male with disseminated TB involving the lungs, liver, and spleen. The case underscores the need for a high index of suspicion, even in the absence of classic risk factors. We also discuss the immunological mechanisms that may influence atypical TB dissemination.