Eight days after referral, a colonoscopy was performed and ileocecal inflammation was confirmed, a hallmark sign of Crohn's disease. After the procedure, he developed high fever with respiratory symptoms (dyspnea and crackles) and a reduced oxygen saturation of 80%. His chest X-ray (Figure 1(a)) demonstrated bilateral alveolar consolidations and a reticular enhanced lung parenchyma in the lower lobes. Amoxicillin/clavulanate was initiated in assumption of the diagnosis of aspiration pneumonia and respiratory support with low-flow oxygen therapy was started. In the absence of clinical and biochemical improvement, treatment was switched to ceftriaxone and metronidazole on day 5. Further respiratory deterioration was noted on day 7, and respiratory support was switched to high-flow oxygen therapy. A chest X-ray and computed tomography (CT) scan (Figures 1(b) and 1(c)) of the thorax revealed increased asymmetric bilateral (right more than left) patchy alveolar consolidations with adjective ground-glass opacity, suggestive for a superinfection above the initial aspiration pneumonia. One day later, the treatment was switched to meropenem. Eventually, gradual respiratory and biochemical improvement was noted. Respiratory support with high-flow oxygen therapy was tapered and switched to low-flow oxygen therapy on day 14, which could be stopped on day 17. Biopsies of the gastric corpus, the terminal ileum and the ileocecal valve revealed chronic inflammation with granulomas. The pathologist noted that these appeared larger and more abundant than normally encounters in Crohn's disease and TB was in the differential diagnosis. Microscopic examination of the biopsy material was not supplemented by mycobacterial culture (not possible because fixed in formaldehyde) nor PCR analysis. Furthermore, work-up for TB included radiological imaging with a brain MRI and abdominal CT scan. TST and IGRA (QuantiFERON) were repeated. Blood, CSF, gastric lavage (three times), and bronchoalveolar lavage fluid were inoculated for mycobacterial cultures (after fluorescence microscopy). Mycobacterial PCR was performed on CSF and faeces (GeneXpert MTB/RIF  in accordance with the KNCV protocol). Because of persistent gastrointestinal symptoms, despite dietary treatment with Modulen , corticosteroids were associated together with precautionary TB treatment on day 15. Beside abnormalities revealed on the abdominal CT scan (discrete ileocecal bowel wall thickening, two lymph nodes with calcification and ascites fluid), investigations for TB came back negative. Bacterial cultures and multiplex polymerase chain reaction-test for viral infections and Pneumocystis jirovecii on bronchoalveolar lavage fluid were also negative. Faeces were negative for parasites. Meropenem was continued till day 19, and the patient was discharged on day 22. A positive evolution was noted on a new chest CT scan on day 50 (Figure 1(f)), with minor residual abnormalities suggestive of a previous infection. Two months after presentation, the family was screened which demonstrated a positive TST (induration of 15 mm) in his 9-month-old sibling, indicating recent exposure of the family to an infectious TB case. Corticosteroids were tapered to stop, and TB treatment was continued for 9 months. Complete clinical recovery was observed and currently, 12 months after finishing the TB treatment, no symptoms recurred.