Hypertrophic pachymeningitis (HP) is a rare disorder that involves dura thickening caused by various infectious, autoimmune, or malignant diseases. One form of this is tuberculous pachymeningitis which is a rare type of extrapulmonary tuberculosis (TB). It usually presents with multiple cranial neuropathies. We report a case of a 40-year-old female with previous history of TB lymphadenitis with chronic otalgia and headache associated with cranial neuropathies initially treated as complicated chronic mastoiditis. MRI brain showed diffuse meningeal thickening. After initial treatment failed to resolve the symptoms, patient subsequently underwent a transmastoid biopsy of the dura of which TB was confirmed. Anti-tuberculosis medication was started, and patient’s condition improved.