Mrs F U, a 35 year old house wife presented with 3 weeks remittent fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling that defied medications including antimalarials, antibiotics and antiemetics at a pheripheral hospital. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. Patient had abdominal ultrasound and other blood investigations on request by medical officer, abdomino-pelvic scan done revealed right ovarian mass measuring 11.8cm x 10cm displacing the uterus anteriorly. Diagnosis of right ovarian cancer was made for which the patient had explotory laporotomy. Histology of the excised lesion showed tuberculous granuloma, on this account the patient was referred to our hospital; a tertiary health facility and center of excellence in infectious diseases and immunology for further evaluation. On clinical examination the patient was wasted, pale, anicteric and had no peripheral lymph node enlargement. Abdomen was flat with healing paramedian incision from xyphiternum to pubic symphysis, with no organomegally or ascites. Other systemic examination was unremarkable. She had haemoglobin (Hb) of 10.3g/dl, features of iron deficiency anaemia on blood film, WBC of 13.8 x109/l, Differentials (lymphocyte 65%, Neutrophil 30%), ESR 110mm/hr. Liver function test and renal function test including urinalysis were all within normal limit. No abnormality was detected on chest radiograph. Macroscopically the cut section looked grayish white; the section showed fragments of tissue displaying a caseating granulomatous inflammation composed of large areas of central caseous necrosis surrounded by epitheliod cells, multinucleated gaint cells, lymphocytes and fibroblasts in keeping with tuberculous granuloma as in Figure 1. Patient tested HIV-1 after counseling. Her CD4 count was 541cells/ul. Patient was subsequently commenced on anti tuberculotic therapy based on the Nigerian National TB control adopted from WHO DOTS programme that recommend quadriple therapy of isoniazid, rifampicin, ethambutol and pyrizinamide for the 2 month intensive phase and continued with isoniazid/rifampicin for another 4 months as continuation phase. Patient responded well to medication as evidenced by disappearance of the presenting symptoms and improvement in appetite within three weeks of medication.