Background: Tuberculous (TB) oesophagitis is a rare manifestation of dysphagia occurring in 0.3% of all gastrointestinal tract TB infections as well as 0.15% of all cases of dysphagia and often is misdiagnosed. This report presents a rare manifestation of TB as a cause of oesophageal stricture. Case presentation: We describe a rare presentation of a patient with grade IV dysphagia due to an oesophageal stricture. Oesophagoscopy revealed a pinhole stricture with evidence of high grade dysplasia on histology. Subsequently an Ivor-Lewis oesophagectomy was performed and histology revealed evidence of active oesophageal tuberculosis. The patient had an uneventful recovery and completed anti-TB medication. Conclusions: Oesophageal TB is a rare but curable cause of dysphagia. It may mimic cancer of the oesophagus and it is usually missed as a possible cause of oesophageal strictures. There needs to be an increased index of suspicion among patients with dysphagia in TB endemic regions.