The diagnosis of musculoskeletal tuberculous infection remains a challenge to clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings strongly suggest the diagnosis. TB, however, must be confirmed by positive culture or histologic proof from the aspiration of synovial fluid or biopsy of the bone or synovium. Prompt diagnosis and treatment of skeletal TB are important to prevent serious bone and joint destruction and severe neurologic sequelae in the case of spinal involvement.