CASE PRESENTATION: A 55 year old female smoker (45 pack-year) with no significant past medical history presented to clinic with a 2 month history of productive cough, pleuritic chest pain, fever, night sweats, and weight loss of 30 pounds. General exam revealed unremarkable vital signs, poor dentition, tongue ulceration, a palpable right submandibular lymph node, and decreased breath sounds in the right upper lungs. Chest radiograph demonstrated rightward tracheal shift and dense consolidation of the right upper lobe. Subsequent CT scan of the chest and neck showed 9.5 x 6.5 x 5.6 cm right upper lobe mass with cavitary component with mediastinal and cervical lymphadenopathy. PET scan demonstrated increased F-18 FDG uptake in the lung mass, tongue lesion and submandibular lymph node. Bronchoscopy with lavage, endobronchial biopsy, and endbronchial ultrasound with transbronchial needle aspirate of lymph nodes were all non-diagnostic. The tongue mass was concurrently evaluated by biopsy which revealed squamous cell carcinoma. After multi-disciplinary discussion, she underwent glossectomy, radical neck dissection, and tracheostomy. Meanwhile, her right upper lobe progressively collapsed and appeared to be predominantly necrotic on CT. She subsequently underwent right upper lobectomy. Pathology of resected lung revealed sulfur granules consistent with actinomycosis. She was treated with amoxicillin for 6 weeks and had complete resolution of her pulmonary symptoms.