A 21-year-old man presented with upper abdominal pain since 3 months associated with intermittent vomiting, melena, and 7 kg weight loss. Clinical examination revealed pallor with lump in epigastric region approximately 2 cm x1.5 cm in size. The lump was nontender, moving with respiration, with normal overlying skin and temperature. Routine blood investigations are summarized in Table 1. There was microcytic hypochromic anemia. Upper GI endoscopy revealed a large deep excavated ulcer in the esophagus at about 25 cm from the incisors and associated ulcer of size 2 cmx1.5 cm with a suspicious fistulous opening seen in the antropyloric region. Computed tomography (CT) of abdomen revealed diffuse circumferential thickening involving the antrum and pylorus together with thickening involving the proximal transverse colon for a length 7 cm, with multiple necrotic perigastric and periportal lymph nodes. Colonoscopy showed nodular mucosa with superficial ulceration in proximal transverse colon. Histopathology from esophageal, antral, and transverse colon ulcer biopsies showed prominent lymphoid aggregate with occasional caseating granuloma and Langerhans giant cell (Figure 2A). Tuberculosis culture using Mycobacteria Growth Indicator Tube (MGIT) was positive from the antral and transverse colon biopsy specimens. Patient was started on antituberculous treatment regimen consisting of isoniazid 5 mg/kg, rifampicin 10 mg/kg, ethambutol 15 mg/kg, and pyrazinamide 25 mg/kg body weight for initial 2 months followed by isoniazid and rifampicin in same dose for another 7 months. Repeat upper GI endoscopy after 4 months of treatment showed healed esophageal and gastric ulcer with healed fistula (Figure 3A). He is asymptomatic and under regular follow-up.