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. Tuberculosis patients are rarely asymptomatic. Acute virus   myocarditis presents with a wide range of symptoms, from mild dyspnea or   chest pain to cardiogenic shock and death. Case Outline. A 26-year-old   Caucasian man non-smoker presented with one-week history of lower   extremities’ swelling. The patient’s medical history also revealed a two-day   episode of subfebrile temperature with scanty hemoptysis three weeks prior to   admission. The episode had not provoked him to seek medical care. Physical   examination revealed generalized oedema, and laboratory analysis showed signs   of acute renal insufficiency. Enlarged heart and hilar shadows, bilateral   massive cavitary pulmonary opacities and pleural effusion were found at chest   radiography. Sputum smears were Mycobacteria negative on direct microscopy.   Electrocardiogram changes and echocardiography were suggestive of acute   myocarditis with dilated cardiomyopathy. IgM titer to adenovirus was   positive. Under diuretics, angiotensin-converting-enzyme inhibitor,   beta-blocker, antibiotics and bed rest, fast heart compensation and renal   function repair were achieved. Radiographic pulmonary changes promptly   regressed except for a cavity in the right upper lobe. Bronchial aspirate   from the affected lobe was Mycobacteria positive on direct microscopy and   culture positive for Mycobacterium tuberculosis. Standard anti-tuberculosis   drug regimen led to recovery. Conclusion. In the unusual common existence of   two diseases whose presentation initially mimicked Wegener’s granulomatosis,   acute dilated cardiomyopathy contributed to pulmonary tuberculosis detection.   To prevent diagnostic delay in tuberculosis, further efforts in population   education are necessary together with continual medical education. [Projekat   Ministarstva nauke Republike Srbije, br. 175095

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report