The presentation of enlarging bilateral neck masses can be a diagnostic challenge and may require multiple biopsies. Mycobacterium tuberculosis cervical lymphadenitis is difficult to diagnose clinically because of the extensive list of differential diagnoses (eg, metastatic carcinoma, lymphoma, branchial cleft cyst, sarcoidosis, and infectious and inflammatory disease). If the results of a complete head and neck examination and a metastatic workup do not reveal a diagnosis, cervical TB should be considered. A history of exposure, a positive purified protein–derived tuberculin skin test result, and a chest x-ray with findings consistent with prior exposure are helpful in the preoperative evaluation. A high clinical suspicion for this entity is necessary.