A 30-year-old male presented with a 1-year history of right ankle pain and swelling. He denied any history of recent infection but had had recurrent ankle pain that had been treated accordingly. When he visited our outpatient clinic, he was afebrile but had fullness of the right ankle when compared to the unaffected side (Fig. 1). There was no skin lesion, and the right ankle had almost a full range of motion except terminal restriction of dorsiflexion. Radiographs of the ankle showed apparently normal tibiotalar joint in comparison to the contralateral side (Fig. 2). We suspected osteochondral injury of the talus and advised magnetic resonance imaging (MRI) and it showed lesions over the tibiotalar joint with joint effusion and cartilage destruction of the ankle joint (Fig. 3). On admission, laboratory findings included a white blood cell count with normal values. The erythrocyte sedimentation rate was 30 mm/h and C-reactive protein was slightly elevated. Rest all laboratory investigations were normal. In view of long-standing symptoms and MRI findings, inflammatory/pyogenic arthritis or neoplasm like osteoid osteoma of talus was suspected. With the patient in a supine position, under spinal anesthesia, the tibiotalar joint was visualized with an arthroscope after placing two standard portals. Arthroscopy was preferred because it is minimal invasive and was ideal to get tissue of interest for further investigation. Whole articular cartilage has already destroyed with lesion in the distal tibia and talus (Fig. 4). Adequate debridement of the denuded cartilage and loose bodies with synovial tissue was done. In addition, microfracture of the exposed bone was done, and the specimen was sent to histopathological analysis and polymerase chain reaction (PCR)-GeneXpert studies. The patient was advised for nonweight bearing and ankle joint mobilization. Prophylactic antibiotic treatment was given postoperatively for 24 h. The GeneXpert for specimen showed Mycobacterium TB, without resistance for rifampicin (Fig. 5). Four combined anti-TB drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide) were used for 9 months, and then reviewed periodically in the outpatient clinic and was kept nonweight bearing for 1 month. In view of destruction of articular cartilage, he was proposed for ankle arthrodesis at later date. Clinically, his range of motion was painless and full, he did complain of joint pain on weight bearing for long duration. Follow-up evaluation 2 years later showed no recurrence of infection. Patient has almost full range of movements with terminal restriction of the ankle dorsiflexion. He can walk for short distances of about 100 m with ease. He does drive a van with ease for his transport business. Hence, he is yet to decide for proposed arthrodesis.