Extrapulmonary tuberculosis has variable clinical manifestations, and the infection sites can be anywhere in the body. Owing to the difficulty in obtaining a microbiological diagnosis, it is common to make a presumptive diagnosis using laboratory data, imaging studies, and pathological examination as indirect evidence. In addition, the treatment response to the empirical antituberculosis regimen indicates whether tuberculosis is the correct answer. Here, we present a case of extrapulmonary tuberculosis with multiple mediastinal lymphadenopathies and ocular involvement. The diagnosis was made based on the relevant clinical presentations and typical pathological reports. The patient recovered well after empirical antitubercular treatment. A comprehensive study should be attempted and would provide further help to build the diagnosis.  (J Intern Med Taiwan 2022; 33: 227-232)