Skeletal involvement is a frequent site of extrapulmonary tuberculosis, but an isolated disease of the ribs is rare. This case report studied an adult immunocompetent male patient who presented with constitutional symptoms, pain and point tenderness in two ribs. The diagnosis of rib tuberculosis was delayed due to earlier providers not recognizing the condition. Routine chest X-rays performed in the early stages of the disease did not reveal abnormalities, but computed tomography did. The patient had lytic rib lesions and a swelling of the chest wall soft tissue consistent with a cold abscess. Specifically, the scan was significant for the absence of involvement of the lung, pleura, spine and mediastinal lymph nodes. While routine smears and cultures were negative, a polymerase chain reaction test for Mycobacterium tuberculosis performed on a sample of aspirate from the swelling confirmed the diagnosis. The patient responded to anti-tuberculous drug therapy, made a complete recovery without complications or the need for surgery and has now been disease free for 16 years. The patient had no concomitant pulmonary disease and was not immunocompromised. The timely intervention could prevent complications. This case report reviews literature and recent research on rib tuberculosis. If these research findings are replicated in larger studies, it will pave the way for more effective management of this rare condition.