An octogenarian male who had a treatment history of pulmonary tuberculosis 8 years ago was admitted to his local hospital with chief complaints being shortness of breath on exertion and right chest pain. He was diagnosed with tuberculous pleurisy, and medication with antituberculous drugs was initiated. Because the CT scan showed parietal pleural thickening, he was admitted to our hospital with suspicion of malignant mesothelioma. Granulomatous inflammation and acid-fast bacteria were detected in the pleural specimens obtained by thoracoscopy under local anesthesia. Although the antituberculous treatment was continued, the aggravation of the right pleural thickening was seen on the CT scan, and the multiple lymph nodes and bone metastasis were found on the FDG-PET. The reiterated pleural biopsy revealed the increase of the spindle-shaped atypical cells accompanied by the p16 gene homozygous deletion of the tumor cells, which confirmed the diagnosis of desmoplastic malignant mesothelioma.