A 50-year-old normotensive, non-diabetic, non-asthmatic euthyroid lady was referred to Surgical Gastroenterology Department, Sheikh Russel National Gastroliver Institute and Hospital (SRNGIH) from the Medical Gastroenterology Department of the same hospital on 25th January 2024 with history of intermittent fever for 2 years and significant weight loss over 1 year. Initially, the fever was low-grade associated with generalized weakness and anorexia. She consulted a local physician and took medicines accordingly, but she suffered from similar feverish attacks and weakness more frequently (1–2 month intervals). In August 2023, she developed high-grade fever with nausea and vomiting and was admitted to the hospital where she was diagnosed with Dengue fever and was discharged after a 5-day hospital stay. Afterward, she was fever-free for 15 days and then developed fever with weakness and noticed more rapid weight loss. As antipyretics and antibiotics failed to subside the symptoms, she was again admitted to the hospital and was on intravenous antibiotics suspecting UTI, Urine R/M/E showed plenty of pus cells and culture revealed E.Coli. The high-grade fever became low-grade in nature and persistent. In December 2023, she developed upper abdominal pain along with fever which was colicky in nature, aggravated by meals and subsided on taking oral analgesics. She consulted an internal medicine specialist who did relevant investigations and diagnosed her as a case of cholelithiasis with benign distal CBD stricture with moderate anemia and referred her to a higher center for further evaluation and management. In the Medical Gastroenterology Department, SRNGIH, Bangladesh where she received 2 units of whole blood transfusion. ERCP was performed where papillary stenosis was found and papillotomy, sphincterotomy, and balloon sweeping were done. Endoscopically no CBD stricture found, therefore they transferred the patient to the Surgical Gastroenterology Department for cholecystectomy. On admission, she was ill-looking with below average body built. She was not anemic, non-icteric and vitals were within normal limits. Her bowel and bladder habits were normal. She does not consume alcohol or smoke, and she has no history of addiction to prescription or recreational drugs. She gave no history of TB infection but has a strong history of multiple TB contact. There were no notable personal or family histories of chronic illness except for laparotomy due to intestinal obstruction long back in 2004, where fecal impaction was found during laparotomy. Her vitals were within normal limits, BMI-18kg/m2, with no palpable peripheral lymphadenopathy. The abdomen was scaphoid, soft, non-tender, with no hepatosplenomegaly and audible normal bowel sounds. No other systemic abnormality was found. At the Medical Gastroenterology Department, her hematological and biochemical work up were as follows: hemoglobin 8.4 g/dl, Erythrocyte sedimentation rate 60mm mm/1st hour, MT 03 mm after 72 hours, normal CXR P/A view, S. creatininine-1.0mg/dl, Bilirubin 1.2 gm/dl, SGPT- 35 U/L SGOT- 40U/L, S. Albumin-3.6gm/dl. Ultrasonogram of whole abdomen showed thick and irregular outlined urinary bladder suggestive of cystitis. MRCP showed contracted gall bladder with cholelithiasis with suspected cholecystitis and circumferential thickening of terminal CBD with luminal narrowing and evidence of pneumobilia. But ERCP showed only papillary stenosis with normal CBD. Therefore, a provisional diagnosis of cholelithiasis was made, and was transferred to the Surgical Gastroenterology Department for cholecystectomy. Intra-operatively, the gall bladder (GB) was inflammed with a thickened wall and multiple stones within it. There was mild cholecystic adhesion and enlarged cystic lymph node. No palpable masses were evident in the gallbladder, and the pancreas, liver, stomach, and intestines appeared to be normal. So, laparoscopic cholecystectomy was done with excision of cystic lymph node and the resected specimen was sent for histopathology. At histopathology, the neck area of GB showed Granulomas consisting of multinucleated giant cells and epithelioid cells, along with areas of tissue necrosis; chronic inflammatory cell infiltration was found within the wall [Figure 01]. The lymph node showed multinucleated giant cells, granulomas, and areas of necrosis [Figure 02]. The morphology strongly favors tuberculosis. The post-operative period was uneventful, and category-1 anti-tubercular drugs were started. The patient showed considerable improvement in both surgical recovery and primary symptoms when assessed two months’ post-surgery.