A 60-year-old female came to our hospital with complaints of dysphagia for 4 months (primarily for solids), with loss of weight and appetite. No history of cough with expectoration. No history of fever. Patient was apparently normal prior to these 4 months. Blood investigations revealed leucocytosis with lymphocytosis, with an elevated Erythrocyte Sedimentation Rate. Patient tested negative for Human immunodeficiency virus (HIV). Patient underwent Upper Gastrointestinal Endoscopy by an experienced gastroenterologist which revealed a hemi circumferential ulcerative growth from 30 cm to 34 cm in the distal esophagus from which biopsy was taken (Fig. 1). Contrast enhanced computed tomography of the thorax showed circumferential thickening involving the distal esophagus, no evidence of invasion of adjacent structures seen, enlarged aortopulmonary lymph node with necrosis (Fig. 2). Histopathology revealed ill defined epithelioid granulomas with giant cells and caseating necrosis, no evidence of malignancy, no acid-fast bacilli seen. Tuberculosis-polymerase chain reaction (TB-PCR) was positive. Patient was started on ATT and was asked to review after 2 months of intensive phase of ATT with isoniazid, rifampicin, pyrazinamide, and ethambutol. On follow up patient had symptomatically improved and repeat UGI scopy showed complete resolution of the lesion (Fig. 1). Patient was advised to continue ATT as per the protocol. Patient was completely relieved of the symptoms after 6 months of treatment.