Pulmonary alveolar proteinosis (PAP) is a rare disease of abnormal surfactant production and accumulation. It is typically divided into three main categories: autoimmune, secondary and genetic. The genetic type is more common in children and adolescents, while the autoimmune type is most commonly seen in adults. Here we present an unusual case of autoimmune PAP presenting in an adolescent by mimicking findings of Mycoplasma pneumonia. Although both PAP and Mycoplasma pneumonia may reveal the same findings of the "crazy paving pattern" on computed tomography imaging, it is imperative to distinguish the two as treatment options are dissimilar.