Tuberculous empyema (TE) is an uncommon form of pleural tuberculous (TB). Although the incidence of TE has significantly decreased, it still threatens public health. Patients with TE experience a protracted illness and significant morbidity and mortality risk. Male sex is a significant risk factor for TE. Herein, we report an adult case of TE admitted to a tertiary care hospital of Iran with clinical characteristics, treatment modalities, and outcomes of this disease. The duration of illness and duration of chest tube drainage equaled 7 months and 48 days, respectively. Our patient required surgery despite the administration of antituberculosis drugs and chest tube drainage. Due to the presence of parenchymal lesions, bronchopleural fistula, and failure of lung re-expansion after chest tube insertion, the patient required decortication with the closure of the bronchopleural fistula and additional thoracoplasty. In the case presentation, we emphasize difficulties encountered in the treatment of such patients.