Female patients who present with adnexial mass and weight loss should not be presumed to have ovarian carcinoma until after extensive investigation. This is to avoid the mistake of radical surgery with its attendant morbidity and mortality. An important disease to consider in our environment is ovarian TB that respond well to medication. A 35 year old HIV-1 positive house wife presented with fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. She had no menstrual abnormality. Imaging studies revealed right ovarian mass measuring 11.8 cm x 10 cm. Right ovarian malignancy was highly suspected, for which she underwent exploratory laporotomy. Histopathology result was consistent with tuberculous granuloma. Chest radiograph was normal. Her CD4 count was 541 cells/ul. Patient was commenced on anti tuberculotic therapy based on the Nigerian National TB control and she responded well. Tuberculosis of the ovary can masquerade as ovarian cancer, especially among HIV patients in regions where TB-HIV co infections is endemic, it should be ruled out before performing extended surgery.