DISCUSSION: Most common radiologic manifestations of pulmonary sarcoidosis include hilar lymphadenopathy, perilymphatic nodules and symmetric peribronchial distortion. Cysts and cavities, when present are mostly related to fibrotic changes with advanced sarcoidosis. However, rarely cavities can be the presenting feature of sarcoidosis, as in our case. This condition is called primary cavitary sarcoidosis and is reported in < 0.6% of cases. Three further aspects of our case made it even more interesting. Firstly, most previous reports of primary cavitary sarcoidosis reported cavities in upper and middle lung zones. However, in our case the largest cavities were in the lower lung zones. Secondly, in previous reports lung cavities were generally associated with nodularity or ground glass opacities in other lung areas. In our case lung cavities were the sole radiographic abnormalities. Thirdly, in most previous reports pulmonary lesions were either incidentally noted or the patient presented with cough and minimal other symptoms. Significant constitutional symptoms, as seen in our patient, are rather unusual. Therefore, in our case we established the diagnosis only after an exhaustive work up.