Drug-resistant extrapulmonary tuberculosis (DR-EPTB) represents an escalating global health challenge, complicated by rising rates of rifampicin-resistant (RR-TB) and multidrug-resistant tuberculosis (MDR-TB). Despite growing awareness, DR-EPTB remains underdiagnosed and underreported, often due to presumptive assumptions of drug sensitivity. This case series describes three distinct cases of DR-EPTB: a 34-year-old woman diagnosed with primary MDR-TB involving the lungs and colon; a 41-year-old man with RR-TB-associated arthritis of the elbow joint, following a previous history of pulmonary TB; and a 63-year-old immunosuppressed woman presenting with primary laryngeal and pulmonary RR-TB. These cases highlight the diagnostic complexities and emphasize the necessity of prompt and precise diagnosis facilitated by molecular diagnostics, particularly GeneXpert MTB/RIF. Increased awareness and vigilance for DR-EPTB among clinicians are critical for early detection, effective management, and curbing the spread of drug-resistant strains. © 2025, Indonesian Society of Internal Medicine. All rights reserved.