CASE PRESENTATION: A 69 year old female with long term history of extensive psoriasis treated with methotrexate and adalimumab presented for evaluation of chronic cough and sputum production for 2 years. The cough was present throughout the day, often with prolonged coughing fits, and occasionally woke the patient up from sleep. She had been bringing up 4-5 teaspoons of green to yellow sputum almost every day for 2 years. She denied any fever, night sweats, hemoptysis, weight loss or history of treatment for any lung disease. Chest X-ray showed chronic interstitial disease. Pulmonary function tests revealed a severe restrictive ventilator defect with moderate reduction in gas exchange. High resolution computed tomography (HRCT) of the chest was significant for bronchiectasis with multiple small nodules, suspicious for infection but no fibrosis. Labs, including ANA, rheumatoid factor, serum immunoglobulin, CFTR gene mutation were normal. A subsequent bronchoscopy with lavage was done and the fungal culture came back positive for Paecilomycosis lilacinus.