CASE PRESENTATION: A 63-year-old Caucasian female with a history of mycobacterium avium-intracellulare (MAI) infection who is 2 years status post 18 months of usual treatment is referred to the pulmonary department for progressive dyspnea and abnormal chest CT findings. Within the past year, she was diagnosed with follicular lymphoma after an abnormal routine mammogram followed by lymph node excision and bone marrow biopsy. Due to the absence of bulky disease, treatment was not initiated and she was followed by routine surveillance. CT chest for evaluation of her dyspnea was significant for bilateral diffuse nodular parenchymal opacities, endobronchial nodularity with associated bronchial narrowing, and absence of mediastinal lymphadenopathy. Because of these findings with the lack of systemic involvement, lymphoma was thought to be less likely and bronchoscopic evaluation was pursued. Bronchoscopy showed numerous scattered endobronchial polypoid nodules with near complete obstruction of the right upper lobe junction. Microbiological studies on bronchoalveolar lavage specimen were negative, including fungal and mycobacterial cultures. Endobronchial biopsy was positive for follicular lymphoma, consistent with the patient’s known history. The patient was initiated on RCHOP chemotherapy with plans for follow up bronchoscopy to document resolution.