Secondary spontaneous pneumothorax (SSP) is one of the rare and crucial complications of pulmonary tuberculosis (TB) and can become a fatal condition if it progresses to tension pneumothorax. This case report describes a 32-year-old male who presented with sudden onset chest pain and shortness of breath for the past three hours. On examination, he exhibited tachypnea and hypoxia at rest, and chest imaging revealed a right-sided pneumothorax. Immediate intercostal chest tube insertion was performed and subsequent computed tomography (CT) of the chest was conducted after lung expansion to determine the underlying cause, most likely TB. The patient was subsequently managed conservatively with intercostal chest drain and anti-TB therapy.