CASE PRESENTATION: A 42 year old woman with Sjogren’s syndrome presents with progressive dyspnea, subjective fevers and night sweats. She denied weight loss, cough, or hemoptysis. CT angiography showed diffuse peripheral reticulonodular pattern, ground glass opacities, multiple thin-walled cysts and mild tree-in-bud changes without lymphadenopathy. Video-assisted thorascopic surgery with biopsy of the right upper and middle lobes with histopathologic findings of prominent lymphoid infiltrate, predominantly peribronchiolar with marked plasmacytosis. These findings were initially concerning for mucosa-associated lymphoid tissue-derived lymphoma. After further review, a diagnosis of follicular bronchiolitis was made. After four weeks of oral steroid therapy, there was marked clinical and radiological improvement. Given the increased risk of lymphoma in Sjogren’s syndrome, in addition to her family history of Hodgkin’s lymphoma and the concerning histopathological findings, the patient was started on rituximab for further treatment.