Pleural tuberculosis (PLTB) is a significant form of extrapulmonary tuberculosis. It contributes substantially to exudative pleural effusions in high-burden regions and it often appears as postprimary disease in low-incidence areas. Immunocompromised patients, particularly those with Human immunodeficiency virus, exhibit higher mycobacterial loads and altered diagnostic performance. Management combines standard antituberculosis therapy with procedural or surgical interventions for complicated cases. Timely therapy ensures favorable outcomes, but residual pleural thickening or fibrothorax may persist. This article aims to highlight current evidence on epidemiology, pathogenesis, clinical features, diagnostic workup, and management of PLTB. The role of surgery is emphasized to guide holistic care.