CASE PRESENTATION: A 44-year-old woman from Minnesota, presented with hilar lymphadenopathy, migratory polyarthralgia, fever and painful rash on her shins. Symptoms started abruptly in the winter, with fevers, chills and night sweats associated with chest tightness and shortness of breath. She was treated for pneumonia, with no improvement. Her exposure history was significant only for backyard cleaning and building a pond in the previous summer. She had CT Chest and PET scan done, which showed bilateral hilar and mediastinal lymphadenopathy; they were highly FDG avid on PET scan. She underwent bronchoscopy with ultra sound guided transbronchial needle aspiration (TBNA). She also had fungal serologies and urinary antigens ordered. Pathology from skin biopsies and TBNA were positive for granulomas. The initial working diagnosis was Sarcoidosis with Lofgren Syndrome. However, her urinary antigen came back positive for Blastomyces. She was started on oral itraconazole.