A 74-year-old male presenting with exertional dyspnea was admitted to our hospital. Chest CT images showed infiltration in the right upper lobe and pleural effusion in the right chest. Bronchoscopy showed normal findings, and thoracentesis showed exudative pleural effusion with cytology of 99% lymphocytes, no malignancies, and ADA of 14.4 IU/L. After thorough examinations, antituberculosis drugs were administered as a diagnostic therapeutic trial. The patient was later diagnosed as pulmonary tuberculosis from positive sputum culture. Six months later, his infiltration improved, but his pleural effusion increased. Thus pleural biopsy was conducted, and non-AA amyloid deposition in the pleura was found. He was later diagnosed as pleural amyloid light-chain amyloidosis complicated with primary macroglobulinemia. In tuberculous pleurisy, pleural effusion examinations have low sensitivity in tuberculosis detection, but pleural biopsy has high sensitivity in tuberculosis detection and can also detect other complicated diseases. Pleural biopsies should be conducted more frequently.