Background: Pleurisy tuberculoma (PTM) is a benign proliferative disease that occurs most commonly after effective treatment of tuberculous pleurisy. In this study, we investigated the risk factors for PTM. Methods: The data of 56 consecutive tuberculoma patients treated at the Nanjing Thoracic Hospital and the Second Hospital between March 2013, and April 2020, were extracted from the hospital database and reviewed retrospectively. Sixty patients treated effectively for tuberculous pleurisy without PTM were included as the control group as most cases of PTM have a history of tuberculous pleurisy. We analyzed the clinical characteristics, laboratory examination results, and imaging features to identify potential risk factors for PTM.Results: The mean age of the PTM patients was 29.04 ± 6.95 years, with no difference between males and females. The onset of PTM was 4.29 ± 2.34 months from the diagnosis of tuberculous pleurisy. The PTM lesions were more commonly located in the lower lobes with no difference in the left and right lung distribution. There were no significant differences in the presenting symptoms and underlying disease of the patients in the PTM and control groups. Pleural thickening was more common in the PTM group (44.64% vs. 23.33% respectively, P = 0.015) and ADA activity was higher (48.32± 19.19 vs. 44.79± 24.57) compared with the control group. There were no significant differences between the groups in terms of the absolute numbers of CD4 + and CD8+ T lymphocyte cells or the CD4+/CD8+ T cell ratio (P > 0.05 ). Expression of the activation marker Ki-67 on CD4+ and CD8+ T cells was significantly increased in the PTM group compared with the control group (P < 0.05).Conclusions: Our results indicate that dysregulation of T lymphocytes may be a potential risk factor for PTM.