Background: Extrapulmonary tuberculosis (EPTB) accounts for 15–20% of tuberculosis cases, with lymph node involvement being the most common form. Postauricular lymphadenitis is a rare presentation and often mimics bacterial abscesses or neoplastic conditions, delaying diagnosis.

Case Report: We describe a 65-year-old female with type 2 diabetes mellitus, chronic kidney disease, coronary artery disease, hypertension, dyslipidemia, and a history of left MCA infarct, who presented with a painful postauricular swelling and fever. Investigations revealed anemia, leukocytosis, elevated ESR and CRP, renal dysfunction, and poor glycemic control. Ultrasound of the local site showed necrotic, matted lymph nodes. FNAC showed reactive lymphadenitis, but incision and drainage of pus revealed acid-fast bacilli, confirming tuberculous lymphadenitis. The patient was managed with anti-tubercular therapy (ATT) as per NTEP guidelines, along with antibiotics, incision and drainage, and optimization of comorbidities.

Conclusion: Postauricular tuberculous lymphadenitis is an uncommon form of EPTB. High clinical suspicion, microbiological confirmation, and early ATT initiation are essential for Favourable outcomes, particularly in patients with multiple comorbidities.