Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

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.