Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. It remains both diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy. A thorough history and physical examination, staining for acid-fast bacilli, fine-needle aspiration and PCR are helpful in obtaining an early diagnosis. It is also important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols vary. Treatment monitoring is more complex due to peculiar behavior of TB lymph nodes. Situation has become worse due to sharp increase in the incidence of atypical mycobacteria, poorly controlled HIV epidemic and rise of drug-resistant TB lymphadenitis. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Surgical therapy along with antituberculosis medication can be beneficial in selected patients.