Patent ductus arteriosus beyond the early neonatal period presents with failure to thrive, congestive cardiac failure, and recurrent pneumonia which is similar to the presentation of pulmonary tuberculosis. Both clinical conditions can coexist with significant adverse outcomes if not properly treated. This is a case of a 9-month-old female who had a hemodynamically significant patent ductus arteriosus (PDA). She had a surgical ligation of the PDA, and postoperative recovery was stalled by pulmonary tuberculosis which was initially missed as her post-operative symptoms were thought to have been from a post-op complication. She however progressively worsened till the diagnosis of pulmonary tuberculosis (PTB) was mading a suggestive chest X-ray finding. She was treated for PTB and made remarkable improvement with the resolution of the respiratory symptoms and adequate weight gain. A child with a symptomatic congenital cardiac defect in a TB endemic area can still have pulmonary tuberculosis which should not be missed. Also, the diagnosis of TB in children can be challenging due to laboratory tests that could have relatively poor yield when compared to adults. Hence, to avoid missing the diagnosis, a combination of clinical, laboratory, and regional epidemiology correlation is essential.