An 8-year-old destitute girl was brought by members of an internationally acclaimed humanitarian organization, with complaints of pain and swelling in the left index finger of five month's duration. On examination, she had features of a draining abscess on the dorso-ulnar aspect of the proximal phalanx of the left index finger [Figure 1]. On detailed medical history, she admitted having low-grade fever and significant weight loss over the last four months. Her general examination revealed emaciation with pallor and three small scantily draining axillary ulcers with accompanying axillary lymphadenopathy and an additional satellite ulcer in the midaxillary line near the anterior axillary fold [Figure 2]. Rest of her general and systemic examination was unremarkable. The radiograph showed features of osteomyelitis in the proximal phalanx distal to the physis [Figure 3]. Chest X-ray was normal but tuberculin test was strongly positive about 12 mm. Sedimentation rate was 73 mm/first hour. Aspirate from the small abscess around the sinus of the index finger showed no acid fast bacilli (AFB) on Ziehl Neelsen (ZN) staining and no pyogenic bacteria grew on culture. Fine needle aspirate from the ipsilateral axillary lymph node however, showed granulomatous inflammation with necrosis and additional slide subsequently came positive for AFB on ZN staining. Abdominal ultrasonography was normal. A diagnosis of tuberculous osteomyelitis of the second proximal phalanx, with disseminated tuberculosis in the form of axillary (lymph node origin) scrofuloderma was made. The patient was started on a four drug regimen (isoniazid + rifampicin + pyrazinamide + ethambutol for the first two months followed by isoniazid + rifampin for a total of seven months) as per DOT guidelines. Attention was also given to improve on her nutrition including high protein diet with zinc, calcium, vitamin D supplements and hematinics. The patient was given no splint immobilization for the index finger and active range of motion exercises was encouraged early. The patient was doing better with progressive healing of the bony lesion without any surgery [Figure 4]. The axillary scrofulodermic sinuses were healing, as well and patient was consistently gaining weight and hemoglobin level over months. We have not come across any literature showing concomitant presence of tuberculous dactylitis, axillary scrofuloderma suggesting active disseminated tuberculosis in an immunocompetent child above 6 years age.