Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis, which can present as massive pleural effusion. We herein report a six-year-old male, a follow-up case of acute pancreatitis, who later presented with bilateral pleural effusion due to PPF. Initially, tuberculosis was suspected as the cause of pleural effusion due to the patient’s maternal history of contact with tuberculosis and chronic history and chronic history. However, further investigations revealed a diagnosis of PPF. Management and outcome: He was managed conservatively for a prolonged period, following which there was a complete resolution of pleural effusion. This pediatric case highlights a rare complication of acute pancreatitis and the role of early initiation of management in these patients, thereby resulting in good outcomes even in a resource-limited setting.