The distribution of tuberculosis in the Île-de-France region is characterized by significant disparities across populations and geographic areas. The prison system, where a population with numerous risk factors for developing the disease is concentrated, has a reported incidence rate more than 10 times higher than that of the general population in France. Prisons are also environments that facilitate the transmission of tuberculosis due to close quarters. This article presents the results of a single-center retrospective descriptive study conducted from 2014 to 2018 among inmates at the Fresnes Correctional Facility. On the one hand, it highlights the importance of tuberculosis screening among individuals entering detention, finding an incidence rate of 141.58 per 100,000 in this population, compared to an overall incidence rate of 183.53 per 100,000 for the period. On the other hand, it examines the characteristics of the active tuberculosis cases detected, showing that they are often paucisymptomatic and difficult to confirm bacteriologically. Tuberculosis screening in prisons is an important and sensitive issue, representing a significant challenge for both inmates and staff—whether healthcare workers or not—who work within correctional facilities.