Background: Syncope is a transient loss of consciousness due to global cerebral hypoperfusion and represents a diagnostic challenge due to its heterogeneous etiology ^[1]. Post-tuberculosis (post-TB) lung sequelae may coexist with systemic manifestations, complicating clinical interpretation ^[2].

Case Presentation: A 55-year-old male with no comorbidities presented with recurrent syncopal episodes (>4 episodes over 3 years), occurring suddenly without prodrome. He had a history of pulmonary tuberculosis treated 20 years earlier with a complete 8-month EHRZ regimen. Chest X-ray (PA view) showed a small fibrotic shadow in the left upper zone. HRCT chest demonstrated fibrotic opacities in the left upper lobe without active disease. Holter monitoring revealed sinus rhythm with intermittent atrial tachycardia and one short episode of atrial fibrillation. No pauses or significant ventricular arrhythmias were noted.

Discussion: The absence of sustained arrhythmia or structural cardiac abnormality suggests a probable diagnosis of neurally mediated syncope. Intermittent atrial arrhythmias indicate an underlying arrhythmogenic substrate but are unlikely to explain syncope in isolation ^[3].