Introduction: Tuberculosis (TB) is very common in India, China and other developing countries. World Health Organisation (WHO) had estimated 9.2 million new cases of TB, worldwide in 2006 of which 7.7% were positive for Human Immunodeficiency Virus (HIV). In India, at the end of 2007, there were 2.5 million people living with HIV and AIDS (PLWHA) whereas incidence of TB was 1.8 million cases per year. Tuberculosis is the most common HIV related opportunistic infection in India and caring for patients with HIV/TB co-infection is a major public health challenge. The incidence of tuberculosis is more in people living with HIV infection. So, WHO has developed the strategy of treating HIV/TB co-infection irrespective of patient?s CD4 count. If any HIV positive patient is diagnosed to be infected with tuberculosis, the Antitubercular treatment (ATT) is started along with Antiretroviral therapy (ART). Here, we report a case of skin ulcer due to Mycobacterium tuberculosis on chest, secondary to pulmonary tuberculosis in HIV infected person with varied presentation. Material and Methods: At first pyogenic infection due to Methicillin Resistant Staphylococcus auereus (MRSA) was diagnosed. As the patient did not improve even after the full course of Linezolid therapy for Methicillin Resistant Staphylococcus aureus (MRSA) which was superadded infection, the discharge and also tissue material were collected from the base of ulcer and cultured on Lowenstein __ampersandsignndash; Jenesen media and Ziehl-Neelsen staining were done. The acid fast bacilli were present on staining and growth on Lowenstein - Jenesen media was identified as Mycobacterium tuberculosis. Outcome of study: As the patient was also HIV positive both ATT and ART was started. A significant improvement of the cutaneous lesion was noted after one month of treatment and patient was discharged after another fifteen days. Conclusion: Tuberculosis is very common in India and sophisticated automated system for detecting M.tuberculosis is not available in all centers. Any non-healing ulcer not responding to routine antibiotics must be screened for tuberculosis in developing countries. If tuberculosis is detected, promptly HIV testing must be done so that treatment strategy can be finalised. Word count - 341