A 53-year-old asthmatic male with a previous history of carcinoma of tongue subjected to left hemiglossectomy with suprahyoidal neck dissection 10 years back, was presented with right cervical lymphadenopathy and fever. He was normotensive and euglycemic. He denied of any weight loss, night sweats, and cough. Sputum examination was negative for acid-fast bacilli (Mycobacterium tuberculosis). C-reactive protein was negative and ultrasonography of neck had showed multiple bilateral cervical lymphadenopathy. Suspecting it to be metastatic disease, a whole body F-18 FDG PET/CT was performed which showed metabolically active cervical, mediastinal, abdominal, pelvic, left inguinal and femoral lymph nodes [Figure 1]. Diffuse low-grade uptake noted in the region of soft palate, base of tongue, and valleculae was considered to be physiological. The pattern of increased FDG uptake is not typical for squamous carcinoma for head and neck metastasis and so it raised the possibility of lymphoma. FNAC showed the Ziehl-Neelsen staining to be strongly positive for acid-fast bacilli [Figure 2]. Tuberculin skin test was positive (15 mm induration after 48 h). The patient was started on first line antitubercular medication. Six months later after the initiation of therapy, a follow-up whole body F18-FDG PET/CT scan showed a significant resolution of previously FDG avid lymph nodes but for residual hypermetabolism at right cervical level I, right paratracheal and right axillary lymph nodes [Figure 3]. The maximum standardized uptake value (SUVmax) of different lymph nodes before and after therapy is depicted in Table 1.