A 34-year-old woman presented with 1-month history of intermittent right flank pain and occasional fever. Two-months earlier she had one episode of gross hematuria. Clinically, a ballotable and bimanually palpable vague lump was appreciated in right hypochondrium. She did not have any history of pulmonary TB in the past. A marginally elevated erythrocyte sedimentation rate was noted. Although urine culture was sterile, 10-12 pus cells were seen on microscopic urine examination. Chest X-ray was normal. Contrast-enhanced computed tomography (CECT) showed a heterogeneously enhancing lesion 8 x 7 cm in dimension with areas of necrosis, involving the right kidney with enlarged aortocaval and paraaortic lymph nodes [Figure 1a and b]. Right renal vein and inferior venacava were normal. She then underwent right radical nephrectomy [Figure 2]. Histopathology showed presence of acid-fast bacilli with multiple granulomas consistent with GUTB [Figure 3a and b]. Postoperatively we started oral antitubercular therapy. Patient recovered well, completed her antitubercular therapy, and after 1 year of follow-up she is free of TB.