OBJECTIVE: To emphasize the diagnosis of tuberculosis in patients with vocal fold paralysis. Vocal fold paralysis can be found in patients with pulmonary tuberculosis. It is a rare condition, occurring in less than 1% of the cases. The mechanisms involved include recurrent laryngeal nerve involvement by the inflammatory process in the lung apex or extrinsic compression by a mediastinal lymph node. CASE REPORT: A 20-year-old white man, presented to the otolaryngology service with complaints of hoarseness. On examination, we found a hardened mass in the right cervical region, which was adhered to the deep tissues along with left paramedian vocal fold paralysis. Computed tomography from the skull base to the lung base showed consolidation of parenchymal foci in the left upper lobe, frontal mediastinal, and hilar lymphadenopathy on the left, lymphadenopathy at cervical levels IIA and III on the right, and asymmetry of the right vocal cord. Tuberculin test revealed a strong reaction (11 mm) and sputum test was positive for Koch's bacillus. Drug treatment was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, and after 6 months, the patient was asymptomatic with normal findings on video laryngoscopy. CONCLUSION: Due to the high prevalence of pulmonary tuberculosis in our country, this diagnosis must be remembered by otolaryngologists during routine practice when a patient presents with unilateral vocal fold paralysis.