Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations. Cystic lesions of multiple bones in tuberculosis are encountered less frequently in adults than in children. The multifocal cystic skeletal tuberculosis involving hands and feet is rare, particularly. We report a case of systemic sclerosis that was treated with glucocorticoid and antirheumatic drug for many years and complicated with multifocal cystic skeletal tuberculosis. This case was misled to the diagnosis of staphylococcal pyogenic abscess by the first microbial culture of the draining pus. The sonographic finding suggested rather metastatic bone lesion or systemic inflammatory arthritis such as rheumatoid arthritis. Although it is rare, tuberculosis should be included in the differential diagnosis of multiple cystic systemic skeletal lesions in immunocompromised patients.