A 78-year-old woman with bronchiectasis, numerous prior admissions for bacterial pneumonia, and mitral valve prolapse presented to this hospital with fever and cough for 6 days. The patient reported developing a nagging, persistent cough described as ‘‘inhaling cake crumbs,’’ without sputum production 6 days prior. Concomitantly, the patient experienced low-grade temperatures ranging from 37.8–38.6 C. On presentation to this hospital, the patient reported worsening ‘‘coughing attacks,’’ complicated by diffuse myalgias and generalized weakness. The patient, however, denied recent illnesses or travel. Physical examination was notable for a temperature of 38.9 C, respirations of 29 breaths per minute, an oxygen saturation of 90 % while breathing ambient air, and diffuse wheezing and rhonchi throughout all the lung fields. A chest radiograph showed widespread bronchiectasis bilaterally, but no consolidative opacities, pleural effusions, pulmonary edema, or pneumothoraces (Fig. 1). Computed tomography of the chest without intravenous contrast material demonstrated moderate bilateral bronchiectasis as well as tree-in-bud nodularity throughout the right, middle and lingular segments, suggestive of mycobacterium avium–intracellulare infection (Fig. 2). Two separate sputum samples were obtained, and were subsequently positive for mycobacterium avium–intracellulare. Human immunodeficiency virus testing was negative. The patient was initially prescribed ceftazidime and levofloxacin with transition to clarithromycin, rifampin, and ethambutol for 1 year, with complete resolution of her symptoms. Repeated computed tomography of the chest without intravenous contrast material completed 6 months later demonstrated persistent, moderate bilateral bronchiectasis with near complete resolution of the previously seen tree-in-bud nodularity, suggestive of resolving mycobacterium avium–intracellulare infection (Fig. 3).