This case report describes a 61-year-old rheumatoid arthritis patient with an atypical clinical
presentation of a sore throat. Because of rheumatoid arthritis refractory to conventional disease-modifying antirheumatic drug therapy, anti-TNFα was felt to be indicated, and a screening for tuberculosis was carried out. As the screening for tuberculosis (PPD) was positive, isoniazid was prescribed prophylactically for six months. After eight months of anti-TNFα adalimumab treatment, he developed tonsillar enlargement and modular pulmonary lesions. Histopathological and microbial investigations established the diagnosis of tonsillar tuberculosis.