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Gastric tuberculosis is a rare entity that often coincides with pulmonary involvement at the time of diagnosis. Many cases reported in developed countries are in immunodepressed patients, particularly those with HIV infection. We report the case of a 43-year-old man who presented with weight loss of 14 kg, persistent vomiting and bilateral pulmonary nodes measuring 1.5 to 3 cm in diameter. An ulcerous, hypertrophic gastric lesion was observed by oral digestive endoscopy, such that the clinical, radiologic and endoscopic profile initially suggested gastric neoplasia with bilateral pulmonary metastasis. Examination of the gastric biopsy and of the bronchial aspirate revealed the presence of acid-alcohol resistant bacilli; a culture in Löwenstein-Jenssen medium was positive for Mycobacterium tuberculosis. The patient responded satisfactorily to short-term specific treatment with three drugs.