A 6-year-old Indian boy presented with a month-long insidious onset of pain in his back and left shoulder. He had had a low-grade fever, decreased appetite and weight loss for 2 months. There was no history of trauma, chronic cough, or bowel or bladder complaints. His father was on anti-tuberculous therapy for pulmonary tuberculosis (TB) (sputum positive). On examination, the boy had a gibbus deformity of the thoracic spine . Tenderness was present over the upper thoracic spine and the left shoulder joint.The diagnosis is confirmed by biopsy. Uncomplicated tuberculous lesions of the clavicle and scapula usually resolve with anti-tubercular therapy. Similarly, spinal TB is managed with bracing and anti-TB drugs. Surgery is needed only if there is a neurologic deficit or spinal instability.