We present an unusual cause of lung cavitation and a neck mass in an HIV positive child, initially thought to be tuberculosis. This case report illustrates that the cause for cavitatory lung disease in immunosuppressed children has a large number of possibilities and careful investigation to determine the etiological agent is warranted. Pediatr Pulmonol. 2013; 48:202–205. © 2012 Wiley Periodicals, Inc.