TUBERCULOSIS OF THE RIB WITH COLD ABSCESS MIMICKING BENIGN BONE LESION Tuberculous osteomyelitis of the ribs represents a rare extrapulmonary manifestation of tuberculosis (TB), often posing significant diagnostic challenges due to its resemblance to benign lesions. The case of a 1-year-old boy with a swelling on the left anterior chest wall initially misdiagnosed as sebaceous cyst is presented. The significant growth of the swelling prompted further evaluation to rule out Ewing sarcoma. Clinical examination and imaging revealed multiseptated abscess with left fifth rib lytic lesion. Empirical anti-TB treatment was initiated based on clinical suspicion, which was subsequently confirmed by mycobacterium TB PCR despite a negative mycobacterium culture. The patient showed clinical and radiological improvement following anti-TB therapy. This case underscores the importance of considering TB osteomyelitis in the differential diagnosis of paediatric rib lesions, especially in TB-endemic regions, and highlights the role of prompt diagnostic imaging and empirical treatment to ensure timely management and effective disease containment.