We report an 82 yr old man with isolated intrathoracic lymphadenopathy of tuberculous origin, which is an extremely uncommon presentation of tuberculosis especially in elderly Caucasian patients. The diagnosis was suggested by the computerized tomographic (CT)-scan showing central hypodense areas after contrast, and was subsequently proved by mediastinoscopic biopsy with histological and microbiological analysis. The atypical presentation of tuberculosis together with a negative two-step 5 international units of purified protein derivative (IU-PPD) tuberculin skin test and a frequent contact with a cavernous index case points towards a primary infection in this patient.