Aim and objective: To describe the management and outcome of an isolated pulmonary granuloma due to subclinical Histoplasma infection in a pediatric patient. Background: Fungal infections can lead to variable presentations and include isolated organ involvement or disseminated disease. Histoplasmosis is an infection caused by the fungus Histoplasma and is particularly endemic to the Ohio and Mississippi river valleys. Case description: A 16-year-old male presented with shortness of breath and pleuritic chest pain for a 1-year duration. He lived in a home that was occupied by bats. Chest X-rays and computed tomography revealed a right paratracheal calcification. The patient underwent esophagoscopy and right thoracoscopic hilar mass resection. On pathology, the sections showed necrotizing granulomata with giant cells, but no organisms were identified despite full pathological workup. Histoplasma yeast titers were subclinical at 1:8. No further medical management was pursued, and the patient demonstrated resolving symptoms on follow-up. Conclusion: Management of isolated granulomatous disease in pediatric patients is poorly characterized. The most common cause of necrotizing granulomatous inflammation are infections including mycobacteria and fungal infections, but organisms may not be seen on pathological workup. The exact cause of the granuloma may be idiopathic. Treatment is reserved for patients with a severe disease process and degree of symptoms. Practitioners in areas endemic to Histoplasma should suspect it as a cause of isolated lung nodules in the right clinical setting. Clinical significance: Workup of pulmonary granulomas requires a detailed history and physical exam, and isolated pulmonary granulomas in the pediatric population are rare. Practitioners are encouraged to consider infectious etiologies and consider surgical consultation for diagnosis and treatment.