A 24-year-old unmarried female presented to the outpatient clinic with painful swelling of the right sternoclavicular joint of 2-month duration without any discharging sinus (Figure 1). The swelling was gradually increasing in size and was accompanied with mild pain. The pain was dull, continuous, and limited to the site of the lesion. She also complained of neck stiffness and pain on neck movements. There was no history of any injury. History of cough, weight loss, night cries (severe pain at night), and low grade fever was present for the past 4 months. There was no history of previous tuberculosis or contact with an open case of tuberculosis. She had been prescribed several antibiotics and analgesics at another centre but had no symptomatic improvement. On physical examination the swelling (2 x 3 cm) was present over right sternoclavicular joint and was associated with presence of mild tenderness, erythema, and local rise of temperature. Laboratory tests revealed haemoglobin of 10.4 gm%; total leukocyte count was 10.300/mm3. Her ESR was 34 mm in first hour. She was negative for HIV based on ELISA method. On radiographic evaluation there was destruction with sclerosis on the medial end of the right clavicle along with features of diffuse pulmonary infiltrate (Figure 2). MRI revealed bilateral upper lung lobe infiltrate with arthritis of right sternoclavicular joint, with regional fluid collection. A destruction of the atlanto-axial junction, D7-8 intervertebral disc space along with a pus collection from D5 to D8 region could also be appreciated (Figures 3(a), 3(b), and 3(c)). An early morning sputum sample was sent for Ziehl-Neelsen (ZN) staining and it came out positive suggesting the diagnosis of pulmonary tuberculosis. Fine needle aspiration of the right sternoclavicular lesion was done using a 22-gauge needle and sent for Gram staining, staining for acid-fast bacilli (AFB), histopathology, and cultures including a tubercular culture. The histologic picture was that of chronic inflammation with a caseating granuloma compatible with tuberculosis. The Ziehl-Neelsen stained smear also showed the presence of acid-fast bacilli (AFB), confirming the diagnosis of tuberculosis. The culture for Mycobacterium tuberculosis came out as negative. Antitubercular chemotherapy with four first line antitubercular drugs (rifampicin, isoniazid, ethambutol, and pyrazinamide) was started. The patient had a good clinical response within 6 weeks and was switched to three drugs (rifampicin, isoniazid, and ethambutol) after 3 months of therapy with four drugs. The clinical, haematological, and radiological parameters showed complete healing of the lesion after 1 year of treatment with ATT, which was further continued for a total duration of 18 months. After successfully completing the therapy for 18 months, the patient was followed up for 2 years and showed no recurrence of symptoms.