The 57-year-old was an African male, originally from Rwanda, from where he initially immigrated to Russia. He lived in Russia for 20 years (1984-2004) before he eventually immigrated to Canada in 2004. He started to experience right shoulder pain and stiffness in 2010. There was no history of trauma to the joint and morning stiffness nor involvement of other joints. The right shoulder pain and stiffness progressed in severity over the ensuing three years and became debilitating, limiting his ability to work in construction. He had undergone multiple courses of physiotherapy and had been prescribed high doses of nonsteroidal anti-inflammatory medications without a meaningful response. For the six months prior to presentation, he had been experiencing night sweats without accompanying fever, weight loss, or respiratory symptoms. He did give a history of exposure to MTb while living in Russia as one of his workmates developed pulmonary Tb; however, our patient was not investigated at that time. Examination of the right shoulder revealed minimal swelling and that erythema and warmth were absent, but there was a decreased range of motion. Due to the worsening right shoulder pain and stiffness, a plain radiograph of the chest and shoulder was performed, revealing only an old clavicular injury and that the acromioclavicular and glenohumeral joints were intact. Neither acute nor chronic parenchymal lung, bone, or joint space abnormalities were observed. An X-ray (Figure 1) and MRI (Figure 2) of the right shoulder were therefore performed, demonstrating intra-articular effusion and erosions of articular margins, compatible with a septic joint. The erythrocyte sedimentation rate (ESR) was 68, and HIV test result was negative. Operative drainage and debridement were undertaken, and the thick purulent joint fluid subsequently yielded MTb by direct smear examination with Ziehl-Neelsen staining and nucleic acid amplification tests (NAATs), the Xpert MTB/RIF test, establishing the diagnosis of osteoarticular Tb. Antituberculosis therapy was therefore initiated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) in addition to pyridoxine. The subsequent Tb culture revealed no resistance to the standard first-line regimen RIPE. He was treated with RIPE for 2 months followed by rifampin and isoniazid for 10 months.