Lung cancer and tuberculosis (TB) are common causes of morbidity and mortality in the world. TB is a serious public health problem in developing countries including India, bearing the highest burden. Lung cancer is also increasing everywhere in the globe with India having the highest mortality due to lung cancer in males. Both diseases coexist producing a diagnostic dilemma. The simultaneous or sequential presentation of pulmonary TB and lung cancer within the same patient has been reported in various case series and case—control studies, but the association between them is still controversial. TB is an important risk factor for developing carcinoma lung. The dormant bacilli may activate due to disturbed defense mechanisms. Pulmonary cancer mortality was also higher in patients developing TB, simultaneously or during treatment courses, than in those without. The diagnosis may be delayed and the patient's survival may be decreased. Pulmonary TB coexisting with lung cancer can mask the underlying disorder resulting in delay in diagnosis and management of cancer patients. Here, we present a rare and interesting case of a 52-year-old male who was diagnosed as a case of microbiologically confirmed pulmonary TB and squamous cell lung carcinoma at the same time.