Background: Foundry workers are known to be exposed to silica and have an increased risk of silicosis. There are also reports that state these foundry workers were associated with asbestos-related change in the X-ray results of the lungs. This report discusses a case of localized asbestosis developed in a foundry worker who worked in 12 Korean foundries. Case report: A 49-year-old man who worked at molding and melting for 30 years, presented with sore throat, cough and yellow sputum for 1 month. From physical and clinical examination, pulmonary tuberculosis was highly suspicious; therefore, he was medicated for 6 months. After tuberculosis medication, the radiological finding was reactivation of tuberculosis, and an asbestos body was detected at a transbronchial lung biopsy. During an operation, operators found multiple palpable masses and bullae localized in the right upper lobe (RUL) and performed right upper lobectomy and right middle lobe wedge resection. Using hematoxylin-eosin stain and iron stain, we could detect asbestos bodies by light microscopy. We analyzed the asbestos fiber burden in dry lung tissue by transmission electron microscopy with energy dispersive X-ray spectrometer (TEM-EDX). The fiber type was chrysotile and the fiber burden was 23.26×10? fiber/g dry lung. Discussion: This case study of a foundry worker with localized asbestosis is uncommon in Korea. We found an occupational relationship between the foundry worker and localized asbestosis through various investigative techniques such as measurements taken at his working environment, clinical, radiological and pathological examination of the foundry worker and mineralogical examination of the asbestos fiber.