BACKGROUND: Cavitary lung lesions are commonly identified on thoracic imaging, but typically require further workup for definitive diagnosis.

CASE REPORT: Here, we present the case of a 40-year-old Middle Eastern male who presented with an unusual cause of cavitary lung lesion with associated pleural mass and pleural thickening. He underwent bronchoscopic biopsy and computer tomography (CT)-guided core needle biopsy, both of which were non-diagnostic. Surgical biopsy subsequently revealed hyalinized necrotizing granulomatous tissue, consistent with histoplasmosis, and the patient was treated with itraconazole, which he responded well to.

CONCLUSIONS: This case demonstrates the importance of identifying unusual causes of cavitary lung lesions and emphasizes the role of using proper tissue sampling for diagnosis.

Keywords: Biopsy, Histoplasmosis, Lung Diseases, Fungal, Multiple Pulmonary Nodules, Antifungal Agents, Bronchoscopy, Itraconazole, Lung Diseases, Tomography, X-Ray Computed