This 27 year old woman had thoracic pain associated with breathing and movements for 10 months. Later on she complained about productive cough and fever. A pleural effusion developed. This effusion and the other symptoms did not resolve after therapy with erythromycin. Microbiology, serology and a bronchoscopy were unrevealing. A thoracoscopy was performed yielding epithelioid granulomas in the biopsy specimen from the pleura. Mycobacterium tuberculosis was grown from the pleural fluid. Symptoms subsided rapidly and the patient became well shortly after institution of anti-tuberculous therapy with a combination of three drugs.