Lupus is a multisystem disease with varied clinical manifestations. Cavitary lung lesions in lupus could be secondary to infections, embolism, or underlying vasculitis. We report a man who presented with lung cavitations and was diagnosed as lupus, secondary antiphospholipid syndrome, and plasma cell dyscrasia. The lesions resolved after the initiation of immunosuppressive therapy. All the previous case reports have been reviewed and the possible mechanisms underlying this association are discussed. Lupus (2010) 19, 993-996.