Hypoxemic respiratory failure is a rare presentation of active pulmonary tuberculosis (TB). Though tuberculous acuterespiratory distress syndrome (ARDS) is well documented in medical literature, non-ARDS respiratory failure is seldomreported in active pulmonary TB. We herein report a case, which posed a diagnostic dilemma as it clinically mimickedinterstitial lung disease. Imaging showed unilateral localized smooth interlobular septal thickening along with consolidationwithout significant mediastinal lymphadenopathy. To the best of our knowledge, this rare radiological finding has not beenreported in medical literature as being associated with hypoxemic respiratory failure in pulmonary TB patients.
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