A sixty year old hypertensive and diabetic Asian male was admitted, in March 2020, to the emergency department of our COVID-19 health care center due to recent onset fever (38.6  C), persistent productive cough, chest pain, myalgias, fatigue and respiratory distress. The patient had a past history of TB according to his relatives; however, no medical records were available as he was treated outside Saudi Arabia. He has mentioned unprotected contact with his cousin who has recently recovered from COVID-19 without sharing any further information. Physical examination revealed decreased breath sounds at the lung bases. His saturation of peripheral oxygen (SpO2) was 72%, on room air but he had no respiratory distress. Portable chest X-ray showed bilateral interstitial infiltrates (Fig. 1). Electrocardiogram, cardiac enzymes, coagulation profile and echocardiography were normal. Also, laboratory findings were normal apart from lymphocytopenia (0.59 x 109/L, normal: 1.1-3.2 x 109/L), and increased C-reactive protein [243.3 mg/liter, normal: 0-7 mg/liter], lactate dehydrogenase [944 units/liter, normal: 100-190 units/liter], and ferritin (876 ng/ml, normal: 23-336 ng/ml). Admission chest computed tomography (CT) scans revealed diffuse bilateral ground-glass opacities (Fig. 1B and C). Nasopharyngeal swabs confirmed COVID-19 by Real-Time-Polymerase-Chain-Reaction (RT-PCR) assays using QuantiNova Probe RT-PCR kit (Qiagen) in a Light-Cycler 480 real-time PCR system (Roche, Basel, Switzerland). The patient was admitted to one of the 100 isolation chambers designated for COVID-19 supportive care within our 200-bed polyvalent intensive care unit (ICU), which is the largest in the Middle East. He underwent a full diagnostic work-up for other viral, bacterial, mycobacterial and systemic disorders. A higher level of respiratory support via a high flow nasal cannula (HFNC) was initiated (flow: 60 L/minute, fraction of inspired oxygen 40%) along with awake prone positioning (16-20 hours daily). The rate of oxygenation index [(ROX): oxygen saturation/(fraction of inspired oxygen x respiratory rate)] was maintained over 6 for the upcoming 48 hours indicating successful oxygenation. Empiric therapy for COVID-19 with lopinavir/ritonavir and ribavirin for 14-days, dexamethasone for 7 days, and prophylactic anticoagulation along with supportive ICU care was administered as per hospital protocol. Interestingly, the nucleic acid amplification test (NAAT) that was performed on sputum specimens (Xpert MTB/RIF test) revealed concomitant infection with mycobacterium tuberculosis sensitive to rifampicin. Therefore, the patient was also started on isoniazid (along with pyridoxal phosphate to avoid peripheral neuropathy), rifampicin, pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone up to the present and for four months in total. No side effects of the treatment for COVID-19 and/or TB were recorded, and the patient has made an uneventful recovery. He maintained a ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen >250 during the first week of ICU admission. HFNC and awake prone positioning were discontinued after 12 days. Thereafter, oxygen therapy (2-4 L of oxygen via a nasal cannula) was administered for another four days. Oxygen supportive care was discontinued on day-16. RT-PCR test for COVID-19 and microbiology were negative on day-20. He was discharged to home isolation on day-27, and is being followed-up by our outreach team.