A 56 y/o Caucasian male with h/o psoriasis s/p etanercept 2 years ago was admitted with exertional sob and non-productive cough which got progressively worse for 2 weeks. Pertinent ROS including fever, night sweats, unintentional weight loss are negative. His social history is significant for 5 pack year smoking which he quit 18 years ago. Physical exam showed diminished breath sounds and dullness to percussion on the right side. He was found having right sided chylous pleural effusion. CT scan evaluation of the abdomen revealed marked thickening of the duodenum and proximal small bowel of which biopsy showed acute on chronic enteritis with focal granulomas positive for Mycobacterium Avium complex infection (MAC). He was found to be T cell deficient with CD4 count of 110 and the workup is negative for HIV and TB. He was started on Anti MAC therapy. Subsequently, he developed noninfectious diarrhea, further investigations revealed significant hypoalbunemia besides CT abdomen showing marked retroperitoneal and mesenteric adenopathy with diffuse infiltration surrounding the nodes. His hospital course was further complicated by recurrent pleural effusions, ascites and PJP pneumonia. Despite appropriate antibiotics and management including TPN with medium-chain triglyceride enriched low fat diet, patient's clinical condition deteriorated rapidly resulting in death. Pertinent Labs: wbc: 8.8; H&H: 9.8/29.3; platelets: 275; T. Bilirubin -0.3; AST: 44; ALT: 37; ALP: 202; Hepatits A, B&C are negative; Pleural fluid TG -190; HIV 1&2 NR Albumin 2.0; Total IgG 506. Discussion: Protein losing enteropathy (PLE) is defined as a condition in which excess protein loss into the gastrointestinal lumen, due to various causes, is severe enough to produce hypoproteinemia and hypoalbuminemia. Intestinal lymphangiectasia (IL) is a PLE caused by dilated lymphatic vessels in the intestinal wall due to obstruction of the lymphatics. It is usually seen in AIDS patients when they are infected with MAC involving the GI tract causing enteric protein loss. It was thought to be obstruction of the mesenteric and retroperitoneal lymphatics by MAC lymphadenitis resulting in PLE. Our patient is a non HIV immunocompromised presenting with Chylous effusion and PLE due to disseminated MAC Infection. It was presumed that he was infected during his prior treatment with etanercept for psoriasis and the etiology for his current immunosuppression remained elusive even after cessation of etanercept. Conclusion: This case adds impetus to the current literature for early recognition and management of intestinal lymphangiectasia, a rare cause of PLE in Non HIV immunocompromised patients.