The nasopharynx is the commonest site for adenoid-related pathology. The second common disease in the area is nasopharyngeal carcinoma. Uncommonly other lesions, such as Thornwaldt cyst, lymphoma, or a granulomatous disease can be found. The case of nasopharyngeal tuberculosis (TB) is not well reported, especially if the lesion occurred at the fossa of Rosenmuller (FOR) with the presence of cervical lymphadenopathy. It may be under diagnosed because of its rarity and it does not produce pathognomonic symptoms of TB. We report a case of a 14-year-old Malay girl who presented with left neck swelling for 2 weeks and sore throat. A rigid nasoendoscopy was performed and revealed fullness over the right FOR. A biopsy was reported as chronic granulomatous inflammation suggestive of TB. Ziehl-Nielsen stain for acid-fast bacilli was positive. The patient was started on anti-tubercular drugs and 2-week follow up later showed significant mass regression.