A 37-year-old foreign domestic worker with no history of major infection and 3 previous vaginal births presented with a one-week history of suprapubic pain associated with fever. The patient also experienced loss of appetite and loss of weight. On examination, she was tachycardic with high-grade fever of 38.9 C. Abdomen examination revealed tenderness over her suprapubic area; however, pelvic examination showed no abnormality. Her total white cell count was 5.9 x 109/L, with predominantly lymphocytes (16.5 x 109/L) and monocytes (2.6 x 109/L). Her C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated at 29.9 mg/dl and 100 mm/Hr. Chest radiograph showed bilateral perihilar opacities which could represent enlarged hilar nodes. There was no evidence of fibrosis, pleural effusion, or infective changes (Figure 1). Ultrasound scan showed presence of right complex mass measured 12 x 6 x 6 cm with minimal free fluid at the pouch of Douglas. Cancer antigen 125 (CA 125) was elevated at 97 u/ml. Working diagnosis of tuboovarian abscess was made, and she was treated with a broad-spectrum intravenous antibiotic. Despite 48 hours of parenteral antibiotic, she did not improve clinically. After discussion, she opted for exploratory laparotomy. There were moderate amount of ascitic fluid with the presence of slough and cheesy materials covering the entire abdominal and pelvic cavities. However, there was no tubercle noted over the peritoneal surface. There was a right ovarian cyst measuring 12 x 6 cm and features suggestive of a mature cystic teratoma. Right salpingo-oophorectomy was performed (Figure 2). Peritoneal fluid cytology showed no malignant cells, and there was no acid-fast bacilli (AFB) seen on AFB staining. Mycobacterium culture did not yield any positive AFB even after 6 weeks. In view of high index of suspicion for TB, peritoneal fluid was also sent for polymerase chain reaction (semiauto TB PCR machine, Rotor-Gene Q , Qiagen) testing, which was positive for NTM but negative for the Mycobacterium tuberculosis complex. Bronchoalveolar lavage was done as the patient was unable to produce sputum, which was negative for TB as well. Infective screening such as HIV, venereal disease research laboratory (VDRL), and hepatitis was nonreactive. Histopathological examination confirmed a right mature cystic teratoma. She remained well postoperatively and completed intravenous ceftriaxone and metronidazole for 10 days. She was initially planned for anti-TB (isoniazid, rifampicin, pyrazinamide, and streptomycin) following positive PCR testing for NTB. However, upon discharge, she was sent back to home town immediately by her employer. Hence, we have no further information about her progress.