A 13-year-old male presented with complaints of sudden onset vomiting and palpitations. On examination, pulse was not palpable, and the child had hypotension (systemic blood pressure of 60/40 mmHg). There was no lymphadenopathy. Electrocardiogram showed ventricular tachycardia (VT) [Figure 1]. Cardioversion reverted the rhythm to normal sinus rhythm. Soon after cardioversion, he was asymptomatic and showed no signs of congestive heart failure, and there was no cardiac murmur. There was no history of significant preceding febrile illness, anorexia, or weight loss. There was no family history of cardiovascular diseases and sudden cardiac death. Echocardiography showed left ventricular (LV) ejection fraction of 37%, LV fractional shortening of 20%, LV dilatation with LV end-diastolic dimension of 6.7 cm, and no other structural heart disease. A 24-h Holter monitoring showed ventricular ectopic activity, and the fastest ventricular run consisted of 12 beats with maximum heart rate of 154 and minimum of 82/min. The blood investigations showed hemoglobin: 14.2 g/dl, total leukocyte count: 5100/cubic mm, and creatinine: 0.9 mg/dl, erythrocyte sedimentation rate was high - 37 mm/1st h, and troponin was raised with levels of 149. There was significant mediastinal widening on chest X-ray. Mantoux test was positive with reading of 20 mm after 48 h. Quantiferon gold test for tuberculosis was also positive. Serum angiotensin-converting enzyme levels were mildly raised 89 u/l (normal range: 8-52 u/l). Computerized tomography (CT) chest showed extensive confluent mediastinal and right hilar lymphadenopathy with focal calcification in subcarinal lymph node [Figure 2]. CT coronary angiography showed normal coronaries. Magnetic resonance imaging (MRI) was done which showed mediastinal lymphadenopathy [Figure 3], diffuse LV dilatation, with myocardial edema, subendocardial septal and lateral wall scarring, and punctate mid-wall-enhancing granulomas [Figure 4] consistent with acute myocarditis, with granulomatous cardiomyopathy. Physical examination revealed that there were no palpable cervical, supraclavicular, axillary, or inguinal lymph nodes available for excision or biopsy. Bronchoscopic lymph node biopsy was suggestive of a chronic granulomatous lesion. Bronchoalveolar lavage was negative for acid-fast bacilli. A standard antitubercular regimen was commenced, comprising rifampicin (120 mg), isoniazid (50 mg), pyrazinamide (300 mg), ethambutol (1 g), and pyridoxine (10 mg; all taken once daily) with steroids and amiodarone, which was gradually tapered with completion of antiarrhythmic therapy. On follow after 12 months, the child continued to be asymptomatic with no fresh episode of palpitations. Repeat Holter study done showed normal sinus rhythm with heart rates around 80/min, but the child has no significant improvement in LV function. The child had sudden cardiac arrest 16 months after therapy while at home.