In the presented case, despite the absence of microbiological evidence of TB, the patient’s constellation of symptoms and radiological findings, necrotizing granulomatous inflammation in the pleural biopsy, high ADA levels in the pleural fluid, and granular appearance of the mucosa of the left main bronchus, combined with the patient’s history of living in an endemic region (Guinea-Bissau), made pleural and lymph node TB the most probable diagnosis, warranting treatment according to the guidelines on treatment of TB [14]. The gene discussed is ADA; the disease is inflammatory response.