Here we report an autopsy case of pulmonary tuberculosis and interstitial pneumonia of a 79-year-old woman. In November 2008, she was referred to our hospital because of a pulmonary shadow found on a CT scan, and she was given a diagnosis of interstitial pneumonia. In September 2009, a follow-up high-resolution CT scan showed that ground-glass opacities had developed. She was then admitted because of a dry cough and sputum. Bronchoscopic examination and culture of the bronchoalveolar lavage fluid (BALF) was done. The BALF culture revealed mycobacterium tuberculosis. She was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EB), and pyrazinamide (PZA). Later, after 5 months of treatment she complained of fever and a worsening of dyspnea. Chest X-ray films showed diffuse interstitial infiltrates in both lower-lung areas. A chest CT scan showed a ground-glass shadow in both lower lobes. She was soon readmitted because of high fever, progressive dyspnea, and bloody sputum, which developed into hemoptysis. She died of respiratory failure, and an autopsy was done. Its findings showed epithelioid granulomas, diffuse alveolar damage, and pulmonary fibrosis. The specimen obtained from the lower lobe showed a diffuse alveolar damage (DAD) pattern. There have been few reports describing interstitial pneumonia without immunosuppressants associated with pulmonary tuberculosis. The correlation between tuberculosis and interstitial pneumonia is discussed.