We herein report the case of an 85-year-old woman with tuberculosis (TB) pleurisy presenting as heart failure and bilateral pleural effusions. The patient was admitted to our hospital because of shortness of breath and bilateral pleural effusions. She received diuretics treatment, but the pleural effusions did not resolve. Chest computed tomography revealed pleural effusion with lung atelectasis. Because no definite diagnosis was made after thoracentesis, the patient underwent pleuroscopy. A biopsy of the pleural nodules was done, and the specimen was diagnosed as granulomatous inflammation, suspected Mycobacterium tuberculosis infection. The patient’s pleural effusion resolved after anti-tuberculosis treatment.