Aim: We aim to describe an unusual association between systemic lupus erythematosus (SLE) and tuberculosis and the challenges of managing both simultaneously. Background: Systemic lupus erythematosus is an autoimmune disease with an underlying defect in innate immunity and a predisposition for various infections such as tuberculosis. On the contrary, tuberculosis is known to trigger the onset and/or flare of SLE. Case description: We report a young female with florid manifestations of SLE with proliferative lupus nephritis and coexisting disseminated tuberculosis complicated by tubercular granulomatous tubulointerstitial nephritis (GIN). She was treated with oral prednisolone (1 mg/kg/day) and mycophenolate mofetil (MMF) with antituberculous drugs. Following 6 months of therapy, she achieved complete remission and resolution of disseminated tuberculosis. Conclusion: Molecular methods help in appropriate diagnosis of renal tuberculous granulomas. This report discusses the interactions between tuberculosis and SLE and also reviews therapeutic options of immunosuppression in active lupus with concomitant tuberculosis.