We report a case of a man with locally advanced lung adenocarcinoma and no evidence of metastatic disease presenting with rapid onset pain and swelling of his right second finger. Radiographically and clinically this was felt to be osteomyelitis and he was treated with intravenous antibiotics. He clinically worsened, and upon biopsy was found to have metastatic adenocarcinoma of the digit. He was treated with radiotherapy with some symptom improvement. He shortly thereafter developed diffuse skeletal metastases.