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A 59 years old Indonesian expatriate male who is a chain smoker farmer and housebuilder with no known medical illness presented at Emergency Department, Hospital Teluk Intan, Malaysia with chief complain of acute shortness of breath and severe frontal headache (pain score 7/10). The headache was throbbing in nature but not associated with nausea, vomiting, periorbital pain nor joint pain. In addition, He also had history of prolonged low grade fever and non productive cough for 5 days. There was no complain of chest pain, epigastric pain or limb weakness. There was no history of recent travelling to oversea or jungle trekking. He was also not living in dengue prone area and no recent dengue case or recalled any direct contact with the truberculous-infected persons.
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