CASE PRESENTATION: A 52-year-old Caucasian woman presented with a 3-week history of dyspnea (Medical Research Council scale 1/5), productive cough and one episode of small-volume hemoptysis. She denied having any constitutional symptoms. She was an active smoker (30 pack-year history) and denied recreational drug use. The patient lived in Southeastern Ontario, Canada, and had several birds. She had no recent travel. She did not have any prior medical history, and was not taking any medications. Physical examination was unremarkable, aside from the presence of digital clubbing. Blood work was noncontributory. Chest imaging showed large bilateral apical lung cavities. Bronchoscopy washings were positive for M. szulgai; bacterial and fungal cultures were negative. The patient was initiated on a multidrug regimen consisting of isoniazid, rifampin, ethambutol and moxifloxacin. Moxifloxacin was changed to cotrimoxazole after 6 months due to concerns about tendonitis. Chest imaging obtained after 12 months of therapy showed persistent cavities of unchanged size. Therefore, left upper lobe wedge resection and right upper lobectomy were performed. Antimicrobials were stopped 3 months after surgery (28 months total treatment). Complete resolution of the cavitary lesions was seen on subsequent imaging, and three sputum samples showed no further evidence of M. szulgai one year after surgery.