CASE PRESENTATION: A 56 year old male presented to the clinic with nasal congestion for a few weeks and cough with fever for a few days. He was found to have cold sores on his lips and cellulitis of the right knee, right anterior chest and medial lower abdomen. The patient was started on amoxicillin-clavulanic acid for 2 weeks along with acyclovir. He returned in 2 weeks with acute sinusitis and persisting productive cough and was prescribed another 3 weeks of antibiotics. He returned a month later with worsening symptoms and right sided chest pain. Chest X ray showed bilateral infiltrates and was started on levofloxacin. He presented to the ED 2 days later with shortness of breath and hemoptysis. He was also found to have oral thrush. CT chest showed bilateral infiltrates in lower lobes and 9.3 X 8.1 cm right sided mass. Given his recurrent infections, immunoglobulin panel was ordered which showed reduced levels of IgG 190(650-1650), IgA 33.7(85-543) and IgM 12.6(39-276). Immunoglobulin profile showed absent CD19+ B cells and a low CD4:CD8 ratio. The patient tested negative for HIV. Bronchoscopy was done and BAL was positive for CMV PCR and Haemophilus influenzae. Given his immunocompromised state suppressive antibiotic therapy, valgancyclovir and IVIG infusions were initiated. The patient underwent right thoracotomy and an encapsulated mediastinal mass was removed. Pathology revealed thymoma AB spindle type. The patient continues to require IVIG infusions and adjuvant radiotherapy is being considered for possible microscopic invasion.