Pseudallescheria boydii and its asexual state Scedosporium apiospermum is a well known opportunistic pathogen among immunocompromised patients. However it is rare in immunocompetent patients. The optimum management of this infection is still not clear. The new azoles may show better efficacy than amphotericin B and additional surgery may play a pivotal role. We report a case of Pseudallescheria boydii lung infection in an immunocompetent patient who had an old tuberculous cavity and presumed inhalational exposure. The case highlights difficulties in diagnosis which complicates the selection of antifungal agent/s and the need for aggressive surgical debridement.