A 27-year-old woman was referred to our hospital because of right index finger swelling and an abnormal chest shadow. Although synovial biopsy of the right index finger showed epithelioid granuloma, we did not detect tubercle bacillus from respiratory materials such as sputa and bronchial lavage fluid. Chest CT image and the positive result of QuantiFERON^® strongly suggested pulmonary tuberculosis with tuberculous tenosynovitis of the finger. We started the standard chemotherapy for tuberculosis under the clinical diagnosis. Fortunately, Mycobacterium tuberculosis was cultured from gastric juice we had obtained before starting the chemotherapy. The right index finger swelling and abnormal chest shadows were significantly improved by the combination of chemotherapy and surgical resection of the synovial lesion. Although tuberculous tenosynovitis is a rare disease, we need to suspect this disease when we observe the swelling of the finger that slowly progresses and try to explore pulmonary tuberculosis.