Coexistence of tuberculosis and breast cancer is rare but their existence in same breast is even rarer. Occurrence of breast cancer with axillary lymphadenopathy needs cautious diagnosis, as important management decisions are based on it, over–diagnosis may lead to extensive undesirable surgery. Since both, these lesions have different natural history, their coexistence poses a diagnostic dilemma to both surgeon and pathologist. Herein we report a case of 60–year–old female who presented with complaint of progressively increasing lump in breast over a duration of one year, without any remarkable systemic complaints and no history of previous exposure to tuberculosis. Patient underwent MRM and histopathology confirmed the diagnosis of Invasive Ductal Carcinoma – Medullary variant associated with tuberculosis in right breast with axillary lymph nodes showing tubercular granulomas without evidence of metastatic breast cancer. To our knowledge this is the first case to be reported in Rajasthan. In Indian scenario <5 and worldwide <100 cases are reported. Awareness of such dual pathology is important for early diagnosis and management, particularly in endemic regions of tuberculosis (t.b).