We report on a 41-year old female patient presenting a history of long-term sore throat, in addition to ulcers on both tonsils, the base of the tongue, the hypopharyngeal mucosa, and a laryngeal edema. She underwent diagnostic tonsillectomy and microlaryngoscopy on the suspicion of malignancy. Clinical and histopathological investigations demonstrated granulomatous inflammation with necrosis containing acid-fast rods in the tissue specimens. Furthermore, the presence of acid-fast bacilli in the bronchial lavage suggested the diagnosis of a possibly reactivated pulmonary tuberculosis. The present case provides evidence that pharyngeal tuberculosis may represent the first manifestation of tuberculosis. Therefore, the differential diagnosis of nonspecific symptoms such as sore throat should include tuberculosis as a causative factor.