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Osteoarticular tuberculosis (TB) of long bones is an uncommon manifestation and a frequently challenging diagnosis due to the absence of typical symptoms. We report a case of an infant with tubercular osteomyelitis involving the distal radial metaphysis. He presented with a lytic lesion in the distal radius, which was treated with decompression, debridement and biopsy. The TB was diagnosed by detecting Mycobacterium tuberculosis (low) on cartridge-based nucleic acid amplification test, and histopathological analysis verified the diagnosis. Anti-tubercular medication treatment improved radiological and clinical outcomes. This case emphasises the importance of considering TB as a differential diagnosis for lytic bone lesions in infants, particularly in endemic areas. Early diagnosis through appropriate investigations and combined medical–surgical management can achieve excellent outcomes without growth disturbances or deformities.