Background: Tuberculosis (TB) remains a significant global health concern, ranking as the 10th leading cause of death worldwide. While pulmonary TB is well-recognized, extrapulmonary manifestations, including tuberculous arthritis, are increasingly reported, particularly among immunocompromised patients. This report highlights a rare case of tuberculous arthritis in a middle-aged male with HIV. Case Presentation: A 50-year-old HIV-positive male, on antiretroviral therapy for 2.5 years, presented with chronic monoarthritis of the wrist, characterized by progressive, painless swelling and restricted movement over a year. Clinical examination and laboratory investigations were unremarkable, except for imaging findings consistent with Phemister’s triad. Diagnosis was confirmed via Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) of joint aspirate, which detected Mycobacterium tuberculosis with rifampicin resistance. Conclusion: Tuberculous arthritis should be considered in the differential diagnosis of chronic monoarthritis, particularly in immunocompromised patients. Prompt diagnosis and appropriate therapy can significantly improve clinical outcomes, emphasizing the need for vigilance in such cases.