A 76 years old female presented to our emergency on 20th March, 2020 with a 1.5 month history of low grade intermittent fever, non-productive cough and decreased appetite with an eventual weight loss of 4 kg. She had worsening of symptoms five days prior to presentation with high grade fever followed by breathlessness 3 days prior to her presentation. There was no prior history of pulmonary TB, any recent hospital admission and no known contact with patients or family members having active TB. Her background history revealed that she was hypertensive taking tablet amlodipine 10 mg once daily. On physical examination at the time of admission, the patient was febrile (102°F) and had an arterial blood pressure of 140/80 mmHg, a heart rate of 110 beats/min, respiratory rate of 32 breaths/min and oxygen saturation of 86% on room air. Chest auscultation revealed bilateral crepitation with bronchial breathing on left side. Findings of the remainder of the systemic examination were unremarkable. The arterial blood gas on room air showed a PaO2 of 52 mmHg, PaCO2 of 30 mmHg, HCO3 of 18 mmol, pH of 7.46 and wide alveolar‑arterial gradient (36 mm Hg) suggestive of acute hypoxemic respiratory failure. Routine blood tests revealed the following: hemoglobin level of 11.5 g/dL, a leucocyte count of 7600 cells/mm3, with 90% neutrophils, 7.0% lymphocytes, and 3.0% monocytes, platelet count of 220,000/mm3, serum sodium level was 133 mmol/L, urea was 62.7 mg/dL and creatinine level was 2.72 mg/dL. The erythrocyte sedimentation rate was elevated (65 mm in the 1st hour). Other remarkable blood test findings included serum lactate dehydrogenase 550 U/L, High sensitive C-reactive protein- 55 mg/l, procalcitonin 0.5 ng/ml, NT-pro Brain Natriuretic Peptide level 600 pg/ml, ferritin level 426.2 ng/ml, Troponin-I negative, creatine phosphokinase (CPK) level 430 U/L and CPK-MB 30.7 U/L. Chest radiograph revealed left lower zone alveolar opacity likely lobar consolidation as shown in Figure 1A. Computed tomography (CT) thorax revealed left lower lobe dense consolidation having air bronchogram with underlying effusion as shown in Figure 1 (B-F). Provisional diagnosis of community acquired pneumonia was established. A therapeutic trial of intravenous antibiotics (Ceftriaxone 1gm twice daily and Azithromycin 500 mg once daily) was initiated after collection of cultures along with oxygen inhalation, continuous positive airway pressure and other supportive measures. Culture of blood as well as urine at admission were sterile. A 2D echocardiogram revealed mild concentric left ventricular hypertrophy with preserved ejection fraction, grade 1 diastolic dysfunction and no vegetations. Serology was negative for HIV, hepatitis B and C, malaria, scrub typhus, mycoplasma, legionella, leptospira, and viruses like dengue, chikungunya, cytomegalovirus (CMV) and Epstein–Barr virus (EBV). Throat swab was negative for respiratory viruses including influenza. In view of the height of novel SARS CoV–2 pandemic worldwide, throat swab for SARS CoV–2 was also sent and found to be positive as detected by validated real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay for both E-Sarbeco and RdRP genes. Ziehl Neelsen (ZN) staining of two consecutive sputum smear samples were negative for acid fast bacilli (AFB). GeneXpert Ultra of sputum revealed rifampicin indeterminate Mycobacterium tuberculosis complex (MTBC). Based on these reports, history of patient was again reviewed after enquiring all family members staying along with her. She was confirmed to have had direct contact with her grandson who travelled from France 12 days prior to the onset of acute symptoms and returned back after five days. Thereafter, her grandson also turned out to be SARS-CoV–2 positive. The patient was treated simultaneously with four anti‑tubercular drugs regimen and hydroxychloroquine 400 mg twice daily in addition to antibiotics. No adverse event was reported. Patient was shifted to COVID 19 designated hospital on 24th March 2020 with utmost precautions for further management according to national policy. Written informed consent was obtained from the patient for using clinical records in this study.