CASE PRESENTATION: A 19 year old woman with a history of Crohn’s disease was admitted because of fevers and dry cough for 3 days. She had fever of 103°C with generalized weakness, chills and sweating. She had been started on Infliximab 2 weeks prior to the presentation. Her other medications included azathioprine and 6 mercaptopurine. She had been previously treated with Adalimumab. She had recently travelled to Los Angeles, but denied consuming any unpasteurized milk products. She denied any animal contact in the recent past.. She was found to have bibasal lung nodules on a prior abdominal CT scan. Chest CT revelaed extensive small bilateral nodules, and scattered tree- in-bud appearance, raising the concern of mycobacterial disease. In view of negative acid-fast bacilli smears of sputum and a positive interferon gamma release assay, pulmonary wedge biopsy was obtained which revealed granulomata with caseous necrosis and acid-fast bacilli. Organisms were subsequently speciated as Mycobacterium bovis. Her treatment was complicated by Isoniazid induced elevation of liver function tests and pancreatitis, eventually requiring a modification in the treatment regimen to include Moxifloxacin, Ethambutol and Rifampin. The patient was discharged home with appointments for pulmonary, infectious disease and gastroenterology follow up.