A 23-year-old female patient presented to the skin department with a large ulcer over the left side of her neck. She also had ulcers over the left axilla and chest wall with a discharging sinus. There was a history of loss of weight, appetite, and on and off fever. She had developed neck swellings two years ago for which she was treated with category II antituberculous therapy (ATT) for 6 months. However, the swellings did not subside, rather she noticed a subsequent increase in their size. She was diagnosed as Rosai-Dorfman syndrome, and was administered systemic steroids for three months. When she presented to us in the skin department, she was ill-looking, malnourished and anemic. She had matted cervical lymphadenopathy on the right side of her neck. There was an irregular ulcer 5 inch x 3 inch, the floor covered with slough over the region of left sternomastoid muscle. The base was indurated and formed by matted lymph nodes. There were two irregular ulcers over the left axilla and chest wall, one of which had a discharging sinus. The ulcers were tethered to the underlying indurated tissue [Figure 1]. Clinically, multidrug-resistant tuberculosis (TB), NTI, and immunodeficiency were considered as differentials. Hemogram revealed anemia and elevated erythrocyte sedimentation rate. There was no leukocytosis. Touch smear and sputum were negative for tuberculous bacilli. Mantoux test was negative. Chest radiograph was normal. She was negative for HIV I and II. Pus culture grew Staphylococcus aureus. Her biochemical parameters were normal. Histology showed lympho histiocytic infiltrate in the dermis. She was empirically re-started on ATT category II along with cotrimoxazole. There was very little clinical response to the above treatment and hence culture was repeated. There was no growth from the discharge on blood agar, MacConkey agar and thioglycollate broth after 48 h of incubation. To establish the cause, culture was repeated, which this time grew non pigmented, smooth colonies on Lowenstein-Jensen medium on 7th day of inoculation at 37 C [Figures 2a and b]. The isolate reduced nitrate was urease positive and sensitive to amikacin and patient was started on injection amikacin. The colonies were confirmed as M. chelonae-abscessus by molecular diagnostic method (DNA sequencing). Since she could not tolerate amikacin, she was started on clarithromycin 500 mg orally. Within 2 weeks of institution of clarithromycin, the axillary ulcer and sinus healed. The ulcer over the neck showed a slow response. At the end of 40 days of clarithromycin, the ulcer over the neck, completely healed [Figure 3]. The patient gained wait, and her appetite improved. Clarithromycin was continued for one more month and withdrawn.