A 44-year-old male nonsmoker presented to the respiratory department with progressive left chest pain for 20 days. He had previously been healthy with normal immunity. He had no cough, fever, breathlessness, or sputum production. Physical examination revealed local tenderness on the left 10th posterior rib. Chest computed tomography showed bilateral multiple pulmonary nodules, thin-walled and thick-walled cavities and left 10th rib lytic lesion (Fig. 1a). Whole-body bone scan showed a central defect with the peripheral uptake of the “donut”-like change sign on the left 10th rib (Fig. 1b).
