Tuberculous pleurisy is an inflammation of the pleura that occurs when the pleura reacts to a high degree of metaplasia to the tuberculosis bacteria. It is commonly seen in children and adolescents. It can be divided into dry and exudative pleurisy according to the pathological anatomy. The main symptom of dry pleurisy is limited pinprick-like chest pain, which is worse with deep breathing and coughing. Pleural friction sounds can be heard on auscultation. Exudative pleurisy is often associated with fever, which is mostly moderate to high and can last for several days to weeks. The cough is mostly dry, without sputum or with a small amount of mucus sputum. Large amounts of pleural effusion can compress lung tissue and cardiovascular causing respiratory distress. There are also symptoms of tuberculosis toxicity such as wasting, weakness, loss of appetite, insomnia and night sweats. Patients with tuberculous pleurisy are in a highly sensitive state and should be treated actively. If delayed or improperly treated, the disease may turn into tuberculous pustular chest or leave behind thickened pleural adhesions, which may affect lung function. For exudative pleurisy of unknown etiology, most of them are tuberculous and should be treated as active tuberculosis. The principles of treatment are reasonable and effective chemotherapy and early thoracentesis and aspiration.