A 47-year-old local male presented with an 8-year history of severe disabling palmoplantar psoriasis. He was both hypertensive and diabetic (controlled adult onset). He had no previous history of systemic medications and showed low compliance with phototherapy. He was mainly treated with local applications of steroids, tar, salicylic acid and calcipotriol. The patient was started on acitretin 50 mg daily and 50% urea cream with only marginal response after 18 weeks. Due to the severity of the condition, the patient was screened before etanercept was added. All tests were within normal range, including negative TST and CXR. The patient completed 12 weeks with biweekly 50-mg subcutaneous injections, with minor improvement, followed by 12 weeks on once weekly 50 mg etanercept without significant change. Both drugs were discontinued and the patient was screened again before switching to another anti-TNF; this time IGRA was performed and the result was negative. He started adalimumab therapy and showed a good and stable response for 14 weeks until he developed fever, night sweating, chills, loss of appetite and persistent cough. The condition evolved rapidly, necessitating hospitalization. Bronchial lavage and pleural effusion tabbing of the right lung were both positive for TB by polymerase chain reaction. Anti-TB therapy was started and adalimumab was discontinued. Six weeks later, the chest condition showed marked improvement, while palmoplantar psoriasis worsened and the patient's ability to walk was limited. Based on the recommendation of the pulmonologist and the patient's consent, adalimumab was resumed on the condition of strict compliance with anti-TB therapy and close follow-up by the medical staff. The patient was followed up for 26 weeks, with complete clearance of both his chest condition and palmoplantar psoriasis. Follow-up of the patient will continue in order to rule out recurrence of TB.