A 36 months old girl of low socioeconomic status presented to our department with eight months history of pain and swelling over right dorsal side of her right hand, with apparition of discharging sinus since 2 months. She was treated by amoxicillin-clavulanic acide for 1 month by another doctor without success. There was no family history of previous exposure to tuberculosis infection and no history of trauma. The boy received BCG vaccination at birth. Physical examination showed normal weight and temperature. Swelling on the ulnar dorsal side of her right hand was found measured 2/2 cm. It was tender to palpation with presence of a narrow draining sinus. Examination of others systems was normal. X-ray showed an expansile, cystic and lytic lesion with cortical erosion involving the little finger metacarpal (Figure 1). The blood investigations revealed anemia (haemoglobin - 10 mg/dl), and acceleration of the erythrocyte sedimentation rate (ESR) of 35 mm/h. white blood cells, and c reactive protein (CRP) were normal. A tuberculin skin test was positive (13/12mm) after 48 hours of test dose. Chest radiograph was normal. The overall appearances were suggestive of chronic osteomyelitis, metacarpal tuberculosis or bony tumor. Histopathology of intra-osseous tissus removed at biopsy confirmed the diagnosis of bone tuberculosis, with typical caseous necrosis surrounded by epithelioid and giant-cell follicles. No organisms were cultured in the purulent materiel, and the Ziehl-Neelson test was negative. Antituberculous treatment was commenced with four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) for two months, followed by two drugs (isoniazid and rifampicin) for 10 months. At 24 months follow-up, the patient was pain free, the swelling disappeared, and there was no sign of reactivation (Figure 2).