CASE PRESENTATION: A 28 year old female presented with abnormal chest radiograph (CXR) showing centrally lucent masses, one measuring 3.2 cm in left mid lung and another 4.7 in left lower lung. She was asymptomatic and had normal CXR 3 months ago. She admitted significant smoking history plus methamphetamine and alcohol use. She had quit cocaine. The lung examination was negative. Multiple small healed skin lesions seen were attributed to skin picking during methamphetamine use. Sputum cultures had no growth of bacteria, acid-fast bacilli and fungi. Tests for atypical pulmonary pathogens and immunological work up were all negative. Computed tomography revealed multiple bilateral round consolidations, some with central sparing in mid and lower lungs. Bronchoalveolar lavage and trans bronchial biopsies of left lower lobe showed non necrotizing granulomas consistent with sarcoidosis. Patient was offered treatment with corticosteroids but refused. She was followed for 1 year with serial imaging and remained asymptomatic.