CASE PRESENTATION: This is a 59 year old man with a history of illicit drug use presenting with a fluctuant nodule on his left anterolateral chest (Fig 1). 2 years prior to this presentation, he was diagnosed with pulmonary M. kansasii infection, but was lost to follow up. 3 months prior, he was evaluated for cough associated with hemoptysis and dyspnea and sputum smears for AFB again grew M. kansasii. After questionable compliance with a regimen that included rifampin, isoniazid and ethambutol, our patient noted the aforementioned chest wall nodule. Fluid from the nodule stained positively for AFBs which were demonstrated to be M. kansasii. CT of the chest revealed a broncho-pleuro-cutaneous fistula (Fig 2). Given his clinical stability and improved symptoms with medical management alone, surgical intervention was avoided.