Pulmonary cavitary disease due to Mycobacterium xenopi

•Pulmonary cavitary disease should not refer only to pulmonary tuberculosis.•M. xenopi is usually considered as a nonpathogenic contamination (especially, when isolated from bronchoalveolar lavage); our case highlights that M. xenopi should be considered as a cause of cavitary lesions, especially in patients with an underlying lung disease.•Drug susceptibility testing is not recommended in infections with M. xenopi and should not delay treatment.•Amikacin (aminoglycoside) should be associated with antimycobacterial treatment in case of M. Xenopi pulmonary disease with cavernous/cavitary disease. Non-tuberculous mycobacteria are a significant cause of pulmonary infections worldwide and can be clinically challenging. Mycobacterium xenopi (M. xenopi) has a low pathogenicity and usually requires immunosuppression or lung diseases. We describe herein a scarce case of pulmonary cavitary disease attributed to M. xenopi in a 57-year-old Caucasian patient with underlying structural lung disease successfully treated with rifampicin, ethambutol, clarithromycin, and amikacin.