A 72-year-old woman without any underlying disease presented to our surgical outpatient department (OPD) with a 5-month history of a nodule in the left supraclavicular area and a 1-month history of a mass in the left para-spinal area of the upper back. The patient did not report fever, night sweating, cough, or weight loss. Physical examination revealed a suspicious soft tissue swelling in the left supraclavicular and thoracic spine region. Chest computed tomography and serum tumor marker (CEA; CA-125; CA-153; CA-199) assessments revealed a hypodensity lesion with ring enhancement in the left supraclavicular area and multiple small nodules in bilateral lungs with bilateral mild pleural effusion (Fig. 1A). Tumor markers were all within normal limits. Fine needle aspiration of the supraclavicular and thoracic spine lesions was performed for bacterial culture. Empirical antibiotic therapy was prescribed to the patient. The bacterial culture revealed no growth after 1 week. Because the swelling persisted, incision and drainage of both lesions was performed, and notable volume of pus was seen at both sites (Figs. 1B, 2 A). Although we continued the wound care and antibiotic therapy, the swelling persisted, and the wound did not heal. The patient was referred to the infectious diseases OPD for a second opinion. On reviewing the patient's medical history and data, Mycobacterium tuberculosis (MTB) lymphadenitis was suspected, and a swab sample was collected from the deep supraclavicular wound for TB culture, acid-fast staining, and TB polymerase chain reaction (PCR) testing. Acid-fast staining revealed the presence of acid-fast bacilli on the subsequent day, and TB PCR test returned positive 2 days later. A combination anti-TB regimen was started immediately. Thoracic spine wound and sputum TB survey were conducted simultaneously. The sputum and wound swab tested positive on TB PCR, and the patient was placed in airborne isolation. Although pulmonary TB was confirmed, no respiratory symptoms were noted during the disease course. The patient denied any possibility of HIV infection and refused HIV screening. No exposure history or risk factors of MTB infection were noted. The patient reported a persistent back pain and developed bilateral lower extremity numbness and weakness gradually. Magnetic resonance imaging of the spine revealed a hypointensity signal at the T8-T9 level on T1-weighted imaging and a hyperintensity signal at the same level on T2-weighted imaging with spinal cord compression (Fig. 2B, C). A laminectomy of the thoracic spine was performed with spinal fixation. The tissue sample from the spine was positive on acid-fast staining and TB PCR. Spinal TB was confirmed. After combination therapy with isoniazid/rifampin/ethambutol/pyrazinamide, the swelling in supraclavicular and thoracic lesions disappeared gradually, and the incision wound healed finally. After the surgical intervention, back pain resolved, and the patient regained muscle strength of bilateral lower extremities gradually. Before discharge, TB cultures from the supraclavicular and thoracic wounds, sputum, and spine tissue were all positive and identified as TB complex. The final diagnosis was confirmed as disseminated TB, including pulmonary TB, TB lymphadenitis (supraclavicular), TB spine (T8-T9), and cutaneous TB. Cutaneous TB presented as scrofuloderma, extending from the contiguous lesions, the underlying TB lymphadenitis, and TB spine. After 50 days of hospitalization, the patient was discharged from the hospital and was prescribed a rehabilitation program and an anti-TB regimen at OPD.