A 40-year-old man with CKD presented with painless, slowly growing swelling over the lower part of the sternum of 20 days' duration. There was no history of trauma or local surgery preceding its appearance. He had received treatment for pulmonary tuberculosis 11 years ago and for lymphnode tuberculosis 8 years ago. There was a history of loss of weight of 5 kg over 2 months prior to presentation. There was no history of fever and night sweats. On examination, he was malnourished with right-sided cervical lymphadenitis with matting. There was a 4 cm x 3 cm fluctuant painless swelling in the lower 1/3rd of sternum with no discharge or sinus formation [Figure 1]. Evaluation revealed anemia with hemoglobin 8.8 gm/dl, normal total leukocyte count 4900 /mm3, elevated erythrocyte sedimentation rate 120 mm blood urea 85 mg/dl and serum creatinine 3.26 mg/dl, and serum albumin of 3.1 gm/dl. Chest radiograph revealed old fibrotic strands in the lung parenchyma suggestive of pleuropulmonary tuberculosis. Computer tomography of the chest showed destruction of lower part of the sternum with adjacent abscess formation [Figure 2]. Fibrotic strands were present in the left upper lobe and apical segment of the left lower lobe. Tuberculin skin test was negative. Fine needle aspiration cytology of the sternal swelling was carried out and it revealed areas of necrosis with epithelioid giant cells in clusters. Polymerase chain reaction (PCR) for tuberculous bacillus was positive. Excision biopsy of right cervical lymph nodes revealed numerous epithelioid granulomas with central caseation and surrounded by Langhans giant cells. Keeping the diagnosis of sternal and lymphnodal tuberculosis in view, he was started on antituberculosis therapy. With the four-drug antituberculosis therapy, the patient showed significant improvement. The sternal lesion and the cold abscess resolved.