Tuberculosis is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2012, 8.6 million people fell ill with tuberculosis and 1.3 million people died from the disease . Mycobacterial septic shock, once considered a rare complication of miliary tuberculosis is now being increasingly recognized. Mycobacterial septic shock also referred to as sepsis tuberculosa gravissima can manifest in patients even without widespread dissemination. Mycobacterial septic shock is diagnosed in patients who present with haemodynamic features of septic shock along with clinical suspicion of tuberculosis with positive staining for acid fast bacilli and or recovery of Mycobacterium tuberculosis in culture from sputum, BAL, body fluids or tissues in the absence of a more plausible pathogen . Mycobacterial septic shock carries a grave prognosis and early recognition of the entity is of utmost importance. Here we present a case of mycobacterial septic shock in a patient of chronic renal failure.