Presented here is a case of 46-year-old Hindu male with a complaint of progressive shortness of breath, chest discomfort, fever, generalized weakness, and malaise over 6 months. He had a past history of diabetes mellitus (on oral antihyperglycemic agents) and pulmonary tuberculosis, for which he took DOTS category-1 antitubercular treatment for 9 months about 10 years back. On examination, he was febrile with stable vitals; breath sounds diminished over the right side of chest with stony dull percussion note. A provisional diagnosis of right-sided pleural effusion was made, and chest X-ray posteroanterior (PA) view confirmed the same. Diagnostic thoracentesis was done, which showed that the fluid was exudative in nature. The microscopy of centrifuged fluid debris strikingly showed microfilariae of Wuchereria bancrofti. Eosinophils and macrophages were in plenty without any evidence of malignancy or lymphoma. The complete blood count confirmed eosinophil >30% with absolute eosinophil count to be 2400 cells. A diagnosis of filarial pleural effusion was made, and he was started on antihelminthic medication. There was a remarkable improvement in his symptoms over 14 days of starting the therapy. He was maintained on drugs for 6–8 months. There was complete resolution of his effusion and respiratory symptoms.