A 15-year-old female presented to our hospital after a delay of 7 months with chief complaints of pain in right leg along with swelling for the past 7 months. Parents initially consulted non orthopaedic doctors at their local vicinity and were advised painkillers and rest but she did not get relief and then was referred to our hospital for further management. The pain was insidious in onset (parents noticed swelling 10 days after the onset of pain) progressively worsened with time but no diurnal variation was present. Pain was more on standing and walking and did not relieve on taking analgesics. There was no history of any preceding trauma, chronic cough, expectoration, respiratory complaints, evening rise of temperature, and weight loss or arthralgia. There was no significant family history of tuberculosis or contact with any tuberculosis patient present. She was afebrile and haemodynamically stable. There was a firm, diffuse, tender swelling over the lateral aspect of distal one-third shaft region of right fibula without any fixity to the overlying skin and no local rise of temperature on palpation. There was mild oedema of the overlying skin, but no discharge or pus from the lesion. The left ankle joint and knee joint were normal with no swelling, tenderness or any restriction in the range of movement. No lymphadenopathy was present. Rest of the systemic examination was normal. A clinical diagnosis of diaphyseal bone tumour with other possibilities including ewings sarcoma, chronic infective osteomyelitis, brodie's abscess, cystic bone lesions were considered. Raised erythrocyte sedimentation rate of 44 mm in first hour with haemoglobin 9 g/dl was present. Tuberculin skin test was positive. Plain radiograph of the right leg showed an intracortical lytic bony lesion with adjacent sclerosis but no cortical breach in fibula shaft region (Figs. 1 & 2). MRI right leg (Figs. 3 & 4) confirmed an intramedullary diaphyseal lesion in fibula shaft, 6.2 cm away from ankle joint, with associated marked thinning of overlying cortex with focal cortical breech along anterior cortex. (suggestive of ewings sarcoma with osteosarcoma kept as another possibility). CT scan of thorax, abdomen and pelvis was performed that showed lungs were clear. The visualized skeleton was normal. Liver, pancreas and both kidneys were unremarkable. There was no free peritoneal fluid or free peritoneal air or abdominal or pelvic lymph node enlargement. Examination of the other systems was also normal. Needle biopsy was done which on histopathology showed (Fig. 5) epitheloid cell granulomas, occasional langhans giant cells and moderate mixed inflammatory infiltrate. Acid fast bacilli were negative on microscopy culture. She was put on category 1 antitubercular regimen, under Revised National Tuberculosis Control Programme (RNTCP) as per revised WHO guidelines. Anti-tubercular therapy included 2 months of daily intensive therapy with four drugs: isoniazid (H) 10 mg/kg, rifampicin (R) 15 mg/kg, pyrazinamide (Z) 35 mg/kg and ethambutol (E) 20 mg/kg followed by maintenance therapy with drugs (HR) in the same daily doses. Currently patient is on anti- tuberculosis treatment (ATT) for past 12 months and reports alleviation of clinical symptoms with healed lesion on plain x-ray radiograph of right fibula taken at 12 months (Fig. 6).