The patient, R.O., age 50, tall and of heavy build, fell ill at the end of May 2009, being treated first in an out-patient department of internal medicine. He presented with symptoms of generalized viral infection such as fever, sore throat and myalgia, whereas physical examination was negative. Transient alleviation occurred after introduction of NSAIDs and clarithromycin, followed however by recurrent rises in temperature, paroxysmal and persistent cough, and malaise after a few days. Additional studies were negative except for an increase in erythrocyte sedimentation rate (ESR) to 95 mm/h, a rise in C reactive protein (CRP) to 46 mg/l and a single gallstone in the gallbladder found on ultrasonography. Cefuroxime, bronchodilatory, expectorant, and antitussic medications were administered with no improvement. Anti-Mycoplasma and anti-Epstein-Barr virus (EBV) antibody levels were assessed due to suspected atypical tracheitis. Whereas antibody titres were non-specific, there was still an increase in ESR to 120 mm/h. Because of persistent symptoms such as fever, weight loss (4 kg in a fortnight), hacking cough and rising ESR, the patient was suspected to have developed sarcoidosis. Then, he was admitted to the Private Clinic "Certus" on 23.06.2009. There were no abnormalities on physical examination. All the laboratory tests such as complete blood count (CBC), blood smear, liver and kidney function tests, cardiac enzyme studies, and tumour antigens were normal except for a further increase in CRP to 103.5 mg/l and non-specific changes on urinalysis. However, urine culture was negative. There were non-specific changes on the chest CT scan and the mediastinal lymph nodes were not enlarged. Amikacin, clindamycin and fluconazole were applied intravenously. Bronchofibroscopy was performed on 24.06.2009 and revealed signs of chronic, superficial bronchitis. The bacteriological tests such as Mycobacterium tuberculosis detection (MB/Bac T), cytological and mycological examination of the bronchial mucus secretion were negative. Due to persistent cough and recognized chronic bronchitis, the patient was given methylprednisolone orally, inhalatory steroids and bronchodilatory medications. Looking for other sources of infection, abdominal computed tomography (CT) was performed on 25.06.2009. This examination showed inflammatory infiltration along the wall of the hepatic flexure of the colon, a small amount of fluid under the right lobe of the liver, small lymph nodes in the liver hilus and along the aorta and a gallstone 4 cm in diameter in the gallbladder (Fig. 1). Normal echocardiography allowed endocarditis to be excluded. Metronidazole was ordered intravenously by the consultant surgeon, who suspected diverticulitis. Diverticula were located in the transverse, descending and sigmoid colon according to subsequent colonoscopy. The patient responded to the treatment, the temperature dropped and the cough went away. He was released home on 2.07.2009 in good general condition on intravenous amikacin for 5 days, to be followed by oral ciprofloxacin, ceftibuten, fluconazole, methylprednisolone and inhalatory ciclesonide and tiotropium. Due to recurrent fever up to 39 C, malaise and further weight loss at the end of July he consulted a surgeon, who suspected the patient to have developed either perforation of the diverticulum or gallbladder empyema. He was admitted to the Department of Surgery on 31.07.2009. Pyrexia, malaise, mild abdominal pain in the right epigastrium and weight loss ca. 15 kg were the symptoms presented. Physical examination revealed an extensive, immovable mass with blurred borders in the right epigastrium with mild peritoneal signs. Laparotomy through the median incision was performed on 4.08.2009. There was a small amount of clear fluid in the peritoneal cavity, whereas the entire abdomen was filled with an unresectable omental mass which was encasing the colon, duodenum and small bowel loops, and reached the lateral walls of the peritoneal cavity and the minor pelvis. The parietal peritoneum was covered with multiple nodules similar to cancerous metastases from 1 to a few mm in diameter. There were enlarged lymph nodes in the liver hilus and in the vicinity of the stomach. There were no signs of gallbladder empyema, even though its wall was thick. Biopsy specimens were obtained from the omentum and peritoneal nodules and the abdomen was closed. The postoperative course was uneventful and the patient was released home on 12.08.2009. The postoperative histopathological assessment showed either low differentiated cancer or malignant mesothelioma. Negative immunohistochemical staining for CD20 excluded lymphatic origin of the neoplasm, whereas positive staining for WT1, cytokeratin 5/6 (CK5/6), CK7 and calretinin confirmed the diagnosis of the epithelial type of malignant mesothelioma. The patient was then admitted to the Department of Oncology on 2.09.2009 for chemotherapy. Despite intensive treatment his general condition deteriorated and he died on 14.09.2009. After death the patient's wife reported that he had lived in the vicinity of an asbestos factory until the age of 14. The local road and his courtyard were hardened with asbestos.