Acute respiratory distress syndrome (ARDS) is an unusual and rare manifestation of pulmonary tuberculosis (TB). The mortality rate of TB with respiratory failure is high. We report a patient who had an initial manifestation mimicking severe bacterial pneumonia with ARDS not responding to antibacterial therapy. Acid-fast bacilli and M. tuberculosis isolates were identified from tracheal aspiration and bronchoalvelolar lavage. Intensive respiratory care and early anti-tuberculosis therapy provided a good clinical outcome.

Keywords: Pulmonary tuberculosis, Mycobacterium tuberculosis, Acute respiratory distress syndrome