Musculoskeletal Tuberculosis (TB) is an uncommon extrapulmonary manifestation of TB which accounts for 1-3% of TB cases. Here, we report a case of TB of the hand in a patient with systemic lupus erythematosus. The patient was referred to the plastic surgery clinic with a chief complaint of progressive left hand swelling and pain of eleven months’ duration. The MRI was inconclusive, showing synovial inflammation of the mid-palmar space and parona’s
space in the wrist. Surgical drainage with acid-fast bacilli staining and histopathology confirmed the diagnosis of TB tenosynovitis of the hand. The patient was started on anti-TB medications and their symptoms improved. After one month, her symptoms returned and she was taken for drainage with tenosynovectomy. Two months postprocedure; she reported improved symptoms with good range of motion. TB of the hand should be suspected in patients with a long history of hand pain and swelling, especially in immunocompromised and autoimmune disease patients. TB medications and surgical intervention are cornerstones in the management of TB tenosynovitis.