Necrotising granulomatous diseases of the lungs exhibit a narrow range of differential diagnoses. Tuberculosis accounts for most of these cases, while sarcoidosis is an uncommon entity in this group but both possess similar clinical and radiological similarities. One must consider a diagnosis of sarcoidosis once the standard anti-mycobacterial medications fail to achieve a clinical improvement. The case described highlights the coexistence of tuberculosis and sarcoidosis which is a rare entity in the medical literature. A 57-year-old male presented with respiratory symptoms and was diagnosed with tuberculosis (TB) demonstrating a polymerase chain reaction (PCR) test positive showing microbial DNA in bronchial washing. The patient started standard anti-TB treatment; however, he did not respond initially. Further investigations led us to diagnose pulmonary followed by skin sarcoidosis, based on histology. After confirmation of sarcoidosis, administered corticosteroids for 6 months simultaneously along with anti-TB treatment; however, anti-TB treatment was prolonged for a total of 9 months. The patient was found clinically symptomless after the completion of treatment during subsequent follow-ups. The use of corticosteroids as an adjunct with standard anti-TB treatment proves beneficial effects on the recovery of patients having a coexistence of pulmonary mycobacterium tuberculosis and sarcoidosis disease conditions.