A 35-year-old male was referred with high-grade fever, a 5 cm × 5 cm fluctuant swelling in the supraclavicular fossa extending into anterior chest wall () and an osteolytic lesion 1 cm × 1 cm in size, in the middle third of the right clavicle (), incidentally found on chest radiograph. The abscess had developed slowly over 1 month, but he developed fever over 3 days. The patient had no prior history of TB or any procedure done in this region. Contrast-enhanced magnetic resonance imaging (MRI) of the clavicle was done to determine extent of bony infection. MRI was reported as an osteolytic focus in the middle one-third of the right clavicle with thinning and erosion of the cortex, associated with heterogeneously enhancing periosseous soft tissues and non-enhancing foci/abscesses. These findings suggested an infective etiology (osteomyelitis). Pre-operative hemoglobin was 10.1 g/dl, leukocyte count was 14,800/mm3, erythrocyte sedimentation rate was 72 mm/h, and C-reactive protein was positive. Patient was HIV, hepatitis B and hepatitis C negative. Chest radiograph showed a heterogeneous opacity in the right middle lobe of the lung. Due to picture of acute abscess formation, decision of primary surgical debridement of the focus was taken. The patient underwent drainage of the abscess and debridement of the clavicle under general anesthesia. The clavicle showed a defect of 1 cm × 0.5 cm in the superior and inferior cortex (-). Samples of pus and sequestered bone were sent for Gram staining, culture sensitivity, GeneXpert, TB culture, and staining. The patient was started on antibiotics empirically till culture reports were available. The patient was referred to chest medicine for opacity in chest radiograph and was diagnosed as pulmonary TB and advised anti-Koch’s therapy for the same. The pus culture revealed growth of methicillin sensitive Staphylococcus aureus, histopathology showed granulomatous inflammation, while GeneXpert and TB culture showed Mycobacterium tuberculosis, sensitive to rifampicin. Blood culture showed no growth. Based on these reports, the patient was started on injectable amoxicillin + clavulanic acid 1.2 g twice daily for week along with anti-Koch’s therapy for 6 months with rifampicin, isoniazid, ethambutol, and pyrazinamide for 2 months and 4 months of rifampicin, isoniazid, and ethambutol. The patient was given a universal shoulder immobilizer to protect the clavicle. Pendulum exercises and elbow range were started at 2 weeks post-operative. Shoulder range of motion exercises were allowed after 4 weeks. Lifting heavy objects were not allowed till osseous healing was seen. The surgical wound healed uneventfully after 15 days. The osseous lesion showed signs of radiological healing at 2 months follow-up, with complete resolution at 5 months follow-up (). At 9 months follow-up, the patient had no complaints and was able to use his arm comfortably to perform overhead activities, including lifting heavy objects ().