A 24-year-old woman presented with nonbilious, nonprojectile vomiting, 1 to 2 hours after meals, with low-grade fever for 1 month. There was loss of appetite with significant loss of weight. Clinical examination showed pallor. Routine investigations are summarized in Table 1. There was microcytic hypochromic anemia. Upper GI endoscopy revealed nodularity with ulceration at the junction of the first and second parts of duodenum with a suspicious fistulous opening (Figure 1A). Asymmetric mucosal thickening involving the junction of first and second parts of duodenum with multiple necrotic perigastric and retroperitoneal lymph nodes was noted on CT abdomen. There was also evidence of a suspicious fistulous communication between proximal transverse colon and jejunum along with clumping of bowel loops on contrast-enhanced CT (CECT). Colonoscopy showed long segment ulceronodular lesion in the transverse colon. Biopsy from the duodenal and colonic lesions showed lymphoid aggregate with multiple noncaseating granuloma (Figure 2B). The TB MGIT culture from duodenal biopsy showed growth of Mycobacterium tuberculosis. Patient was given antitubercular drugs for 9 months. She had complete resolution of clinical symptoms with weight gain. Repeat endoscopy after 6 months of antitubercular therapy showed decreased nodularity with healed fistulous opening in the duodenum (Figure 3B).