The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone-related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient's parathyroid hormone-related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone-related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone-related protein in extrapulmonary tuberculosis.