Background: Extra-pulmonary Mycobacterium tuberculosis (TB) accounts for 17% of notified TB world-wide. Yet TB remains unlikely differential diagnosis when patient presents with undifferentiated neck collection. Case Report: A 27-year-old female presented with a 1-month history of a progressively enlarging central neck lump after 2 days of upper respiratory tract infection. CT showed three separate collection within the bilateral sternal heads of sternocleidomastoid muscle. Ultrasound showed microcalcification. 4mL of purulent fluid was aspirated. PCR confirmed TB. The patient commenced medical treatment with rifampicin, levofloxacin, ethambutol and pyrazinamide. The collection resolved completely at the 1-month follow-up. Discussion: Cervical TB commonly presents as nodal disease also known as scrofula. However, the infection can spread through fascial planes, mimicking other infective neck abscesses such as an infected thyroglossal duct cyst or branchial cleft cyst. Reliance on routine bacterial culture alone may delay diagnosis. Early inclusion of TB tests for those with high risk history provides rapid confirmation. Needle aspiration is usually sufficient for source control. Yet incision and drainage or excision risks chronic cutaneous fistula formation. Conclusion: ENT surgeons should maintain a high index of suspicion in patients with risk factors and engage infectious-diseases team early to optimise treatment and contact tracing. Routine inclusion of TB PCR in the work-up of atypical cervical collections may shorten time to treatment and limit community transmission. Reference: 1. Sasikumar, C., Utpat, K., Desai, U. and Joshi, J., 2020. Role of GeneXpert in the diagnosis of mycobacterium tuberculosis. Advances in Respiratory Medicine, 88(3), pp.183-188. 2. Forget, N. and Challoner, K., 2009. Scrofula: emergency department presentation and characteristics. International journal of emergency medicine, 2, pp.205-209.