A 38-year-old local male presented with a 23-year history of generalized plaque psoriasis. His BMI was 42, with a physician global assessment (PGA) of 4. He suffered from joint pain in both small and large joints, with no radiological findings. He had a positive family history but no history of systemic medications. The patient was screened before administration of infliximab therapy. All tests were within normal range, including IGRA and CXR. Infliximab was initiated with good response and a cessation of joint pain. No side effects were noted in the first year of therapy. During his annual checkup, an IGRA showed a positive conversion though CXR and microbiology for TB were negative; the patient was asymptomatic. LTBI was diagnosed by the pulmonologist and anti-TB treatment was started, with a 1-month cessation of infliximab therapy. The patient was followed up for another year; his condition is stable, with a continued response to infliximab and no side effects. Follow-up of the patient will continue in order to rule out recurrence of TB.