A 25-year-old male presented with complaints of progressive dysphagia for both liquids and solids for 1 mo associated with epigastric pain. The patient described the pain as intermittent, dull, non-radiating, and a 5 in severity on a scale of 1-10, with no exacerbating or relieving factors. The patient reported 10 kg weight loss in the last 8 mo. On review of systems, the patient denied chest pain, dyspnea, productive cough, nausea, vomiting, hematemesis, melena, hematochezia, altered bowel habits, fever, night sweats or anorexia. The patient’s past medical and surgical history was unremarkable, with no prior hospital admissions. He had no known co-morbid conditions. The patient’s personal history was unremarkable with no addictions reported. There was no history of long-standing diseases including cancer in his family. The patient’s physical examination including vital signs was within normal limits. Routine laboratory work-up was done which turned out to be normal. Mantoux test was performed which was negative, and the chest X-ray was unremarkable. A barium-swallow examination was performed which showed moderate dilatation of the distal portion of esophagus with mucosal irregularity and nodularity. Thickening and narrowing of the gastro-esophageal junction was present but there was no evidence of a tight stricture. These findings were suggestive of inflammatory etiology. Barium swallow examination shows slight thickening and narrowing of the gastro-esophageal junction with mucosal irregularity, no Figure Computed tomography sagittal section shows dilated and fluid-filled distal esophagus with significant mural thickening of the distal esophagus. Computed tomography (CT) scan of the chest, abdomen and pelvis with contrast showed significant circumferential thickening of thoracic esophagus. The distal esophagus was dilated and fluid-filled with significant mural thickening near the gastro-esophageal junction. There was significant infiltration in the lesser omentum and enlarged, centrally necrotic lymph nodes were seen in the gastro-hepatic ligament, which pointed towards the possibility of malignancy. During esophagoscopy, a large circumferential growth was visualized starting from the middle and distal part of esophagus, involving the gastro-esophageal junction and extending up to 5 cm into the cardia of the stomach. The growth appeared glandular with thickened folds suggesting adenocarcinoma, neuroendo-crine tumor, or lymphoma. Biopsy of the mural thickening was performed. Histopathological examination showed hyperplastic changes in the mucosa and reactive atypia of the lining epithelium. Severe acute and chronic inflammation was present and occasional dilated glands were seen along with polypoid and pseudo-polypoid formation consisting of ulcer, slough, and granulation tissue. There was no evidence of a neoplastic lesion. PCR was positive for Mycobacterium tuberculosis in the esophageal biopsy. Subsequent cultures also showed M. tuberculosis growth.