Background: CD4+ T cells deficiency generally occurs in human immunodeficiency virus (HIV) patients, leading to some infections such as pulmonary and extrapulmonary tuberculosis. A rare case of decreased CD4+ T cells is idiopathic CD4+ T cell lymphocytopenia, a rare and unexplained immunodeficiency syndrome with no evidence of HIV infection. In this case report, we are reporting a patient with CD4+ T cells deficiency, pulmonary tuberculosis, pleuritis tuberculosis, and meningitis with HIV test negative. Case Presentation: A 58-year-old male was referred to the Emergency Department of Dr. Soetomo General Hospital with a gradual decrease of consciousness following six days of hospitalization at a private hospital. During hospitalization, one liter of fluid was evacuated from the right lung and analyzed, revealing tuberculosis infection. History of diabetes, hypertension, stroke, hepatitis, and cardiovascular disease was denied. The patient also never had chemotherapy or radiation treatment. Based on history taking, physical examination, and laboratory results, this patient has been diagnosed new case of pulmonary tuberculosis with deficiency CD4+ T cells and altered consciousness et causes meningitis tuberculosis with pleurisy tuberculosis. After 32 days of hospitalization with anti-mycobacterium therapy, the patient was improved and was discharged. Conclusion: This case highlights the challenges of having the definitive cause of CD4+ T cells deficiency either active tuberculosis infection or idiopathic CD4+ lymphocytopenia. Therefore, serial analyses of CD4+ T cells are advised on the patient during the treatment with anti-tuberculosis drug.