A 40-year-old presented with pain and mass lower abdomen of five months duration with no menstrual irregularity. General physical examination was normal, local examination was suggestive of fibroid corresponding to size of 18 weeks pregnant uterus. Her routine investigations were normal. Ultrasonography revealed a large single intramural fibroid 10 x 9.7cm with thin endometrium and normal ovaries. Ultrasound guided FNAC was consistent with findings of leiomyoma. Patient underwent a total abdominal hysterectomy. Histopathological examination revealed endometrium in secretory phase, uterine tumor as leiomyoma and in addition myometrium showed caseating epithelioid granulomas along with Langerhans and foreign body giant cells [Figure 2]. Stain for AFB was positive. Screening for tuberculosis elsewhere in the body was negative. Patient was started on ATT despite hysterectomy and absence of tuberculosis elsewhere because the adnexa was left behind where the possibility of a tubercular focus could not be ruled out. Currently patient has completed Category I DOTS therapy and asymptomatic on follow-up.