The authors report a rare case of pediatric tuberculous dactylitis of the thumb with flexor tendon involvement in a child with multiple failed treatment attempts. The patient was diagnosed, treated and the outcome of the one-year follow-up was excellent. Extra pulmonary tuberculosis frequently surprises clinicians with aberrant presentations, which may be missed during radiographic studies, if not considered in differential diagnosis amid its rare location in the appendicular skeleton. This has been highlighted in this rare case of a girl in her mid-childhood with a spindle-shaped swelling with discharging sinuses at the right thumb proximal phalanx. Scenarios mimicking similar presentations such as Enchondromatosis, Chronic pyogenic osteomyelitis, Brodie's abscess and Actinomycosis, can be misleading. Several researchers have proffered up such rare cases, but after the anti-tubercular therapy era, the incidence has been exceptionally reduced. Still, a high index of suspicion can be helpful to avoid missing the diagnosis.