Chest X-ray of a young male patient, having cough, sore throat, rhinitis, shortness of breath and fever but had negative COVID serology. X-ray showed left upper lobe collapse, fibrocalcific changes, atelactatic bands in left lower zone, elevation of ipsilateral hemidiaphragm with few calcific granulomas in right middle zone, these are sequelae of healed pulmonary koch’s. (Consistent with History) In homogenous airspace shadowing in both upper and right mid zones, bilateral pleural effusions suggestive of acute overwhelming infection on background of chronic healed granulomatous disease. Patient was advised for gene expert test to rule out reactivation of pulmonary Koch’s.