Lower lung field tuberculosis (LLFTB) is an uncommon presentation of pulmonary tuberculosis and is often misdiagnosed as bacterial pneumonia or other lower respiratory tract infections. Its atypical radiographic pattern and transient response to empirical antibiotics can delay definitive diagnosis. We report the case of a 50-year-old male who presented with recurrent episodes of acute febrile respiratory illness, each separated by a two-week symptom-free interval. The patient required hospitalization on three occasions. Each episode showed partial remission with empirical antibiotic therapy, but symptoms recurred after antibiotic withdrawal. Chest radiography demonstrated infiltrates confined to the lower lung fields. HRCT (high resolution computerised tomography) imaging’s documented nodular infiltrates in right middle and lower lobe with mild pleural effusion. Given the recurrent nature and incomplete resolution, flexible bronchoscopy was performed as a point-of-care diagnostic tool, revealing endobronchial changes suggestive of tuberculosis and yielding bronchial washings positive for Mycobacterium tuberculosis on GeneXpert MTB/RIF assay. The patient was initiated on standard first-line anti-tubercular therapy with marked clinical and radiological improvement, and no further relapses over a 6-month follow-up. LLFTB can mimic recurrent bacterial pneumonia. Early bronchoscopy at the point of care facilitates timely diagnosis and initiation of specific therapy, preventing repeated hospitalizations and morbidity.