Establishing the diagnosis of miliary tuberculosis (TB) can be challenging due to the heterogeneous clinical presentations and low sensitivity of diagnostic tests. Miliary TB shares overlapping clinical, radiological, and histopathological features with other chronic granulomatous diseases, such as sarcoidosis, often posing a significant diagnostic challenge for clinicians. A 36-year-old male from Haiti presented with a four-month history of recurrent fever, dry cough, night sweats, and weight loss. Chest imaging revealed innumerable widespread miliary nodules throughout the lungs bilaterally, raising a high clinical suspicion for miliary TB. The work-up for bacterial, fungal, and viral infection was negative, and there was no evidence of malignancy. Surprisingly, extensive TB testing yielded negative results. The interferon-gamma release assay (QuantiFERON TB Gold Plus®),