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Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide, particularly among patients with human immunodeficiency virus (HIV) infection. Esophageal involvement is an exceedingly rare manifestation of extrapulmonary tuberculosis. Owing to its clinical and endoscopic features, it may mimic neoplastic disease, thereby complicating early diagnosis. We present the case of an immunocompromised patient with constitutional symptoms and dysphagia. Upper gastrointestinal endoscopy revealed a large ulcerated esophageal lesion highly suggestive of malignancy; however, histopathological and microbiological examination confirmed its infectious etiology.