The coexistence of lung cancer and pulmonary tuberculosis (TB) is rare, and the clinical and radiological features are always similar between lung cancer and pulmonary TB. In the present case, a non-small cell lung cancer patient with an epidermal growth factor receptor (EGFR)-sensitive mutation was diagnosed with pulmonary TB during the treatment of tyrosine kinase inhibitor (TKI) because of the discrepant and confusing responses among different lesions. Therefore, we should combine clinical and radiological characteristics with pathological and microbiological tests to confirm the diagnosis of TB or lung cancer. It is a safe and selectable therapeutic strategy to treat EGFR mutant lung cancer patients with active TB using anti-TB medications and TKIs simultaneously.