Granulomatous neck masses are rather common. The differential diagnosis here includes mycobacterial adenitis, sarcoidosis, and cat-scratch disease due to Bartonella henselae. The incidence of mycobacterial lymphadenitis, however, is on the rise among both immunocompromised and immunocompetent individuals. The usual presentation of granulomatous disease in the neck is simply single or matted nodes. Although mycobacterial adenitis can extend to the skin and drain externally, this presentation is rather rare. FNA biopsy is usually the best initial diagnostic approach. Here, cytology, a smear for acid-fast bacilli, a mycobacterial culture, and a sensitivity test can all be done. PCR from FNA is the most sensitive test and is particularly useful when conventional methods have not been diagnostic but the practitioner’s clinical impression remains consistent for tuberculosis infection. While FNA has a high sensitivity (about 88%), its specificity is low (49%) and an excisional biopsy is often required to confirm the diagnosis. For atypical lymphadenopathy, treatment depends on the sensitivity results of the culture. Antibiotics, however, such as isoniazid (six months standard dosage) and rifampin (two months of the standard dosage) tend to be effective.