Tuberculosis (TB) is a relatively common infectious complication in the dialysis population. Most cases are extrapulmonary and pose a diagnostic dilemma for the clinician. Tuberculous arthritis is a rare form of extrapulmonary TB occurring in approximately 1 % of cases in nonuremics. Only 1 case in a dialysis patient (not proven by positive synovial fluid culture) has been reported. We report here a culture-proven case of tuberculous arthritis in a hemodialysis patient which masqueraded as an acute septic arthritis. TB should be considered early as an etiologic agent along with synovial biopsy when the exact cause of a monoarthritis has not been discovered, thus avoiding delay in initiation of appropriate therapy.