A 15-year-old girl was admitted with chest pain, progressive shortness of breath, fever, nonproductive cough, decreased appetite, weight loss, and fatigue. The patient was born in Angola, but had lived in the Netherlands for 14 years. Seven months before admission she had traveled to the Democratic Republic of Congo in Western Africa. Her temperature was 39.7°C, her pulse 90 beats/min, respiratory rate 28 breaths/min, and blood pressure 96/58 mmHg. No enlarged lymph nodes were found. Soft cardiac tones and a friction rub were noticed. The liver was enlarged. Laboratory results showed normal white blood cells and platelets with a decreased hemoglobin (4.3 mmol/l). The erythrocyte sedimentation rate was 60 mm/h. 1 Fig. 1 RV LV LA PE  M. tuberculosis Discussion 6 5 4 Mycobacterium tuberculosis 2 6 3 1 1