Tuberculous pleural effusion (TPE) is among the most common forms of extrapulmonary tuberculosis (TB), which often presents as an acute disease with fever, cough, and pleuritic chest pain. Pleural fluid associated with TPE is an exudate that predominantly contains lymphocytes. The gold standard for the diagnosis remains the detection of Mycobacterium tuberculosis in pleural fluid, biopsy specimens, either by microscopy or culture, as well as a histological demonstration of caseating granulomas in the pleura along with an acid-fast bacilli test. This study presents a case of a 22-year-old female patient with pleural effusion. The diagnosis indicated TPE based on pleural biopsy specimens from the medical thoracoscopy performed. The recommended treatment is a regimen with isoniazid, rifampin, and pyrazinamide for 2 months followed by 4 months of isoniazid and rifampin.