A 76-year-old male with a past medical history of chronic obstructive pulmonary disease and atrial fibrillation presented for necrotic left lower lung mass (Fig. 1). The patient was originally from Mexico and moved to California over 20 years ago and has never returned since. There was no active animal exposure nor prior travel history to Asia. He was diagnosed with stage IIIa squamous cell lung carcinoma via bronchoscopy. Initial infectious workup was negative except for a positive QuantiFERON test. He was diagnosed with latent tuberculosis and was started on a 4-month course of rifampin while pending initiation of paclitaxel and carboplatin. He then presented for hospitalization approximately 2 months later for worsening dyspnea and cough prior to the initiation of chemotherapy. It was noted that prior fungal bronchoalveolar lavage cultures resulted in T. marneffei and were started on liposomal amphotericin B (L-amB) given severe lung involvement in the setting of malignancy. His course was complicated by an infusion reaction with L-amB leading to acute respiratory failure needing transfer to the medical intensive care unit (MICU). The patient was switched to posaconazole due to significant contraindications with concurrent use of itraconazole, or voriconazole with rifampin. Plan was to continue Pposaconazole until completion of rifampin, then switch to itraconazole. The patient was stabilized and transferred out of the MICU prior to discharge home. He later expired outside of the hospital due to the progression of pulmonary malignancy.