Axillary lymphadenitis in the setting of breast cancer raises suspicion for metastasis. However, there are other causes of lymphadenitis, which can present at the same time as breast cancer. In endemic countries particularly, tuberculosis should be considered in the differential diagnosis as it could lead to unnecessary and incorrect treatment. In our report, a 75-year old Hispanic woman with a right breast lump and enlarged lymph nodes detected by ultrasound was diagnosed with infiltrating ductal carcinoma, while the axillary lymph nodes had caseation granulomas that were positive for acid-fast bacilli. While no definitive guidelines exist, it was decided that anti-tuberculosis treatment should preclude radiotherapy to avoid disease reactivation.