CASE PRESENTATION: A 49-year-old non-smoker female presented with dyspnea and productive cough for 2 days. She denied hemoptysis, leg edema and having any environmental, social or occupational risk factors for HIV. On examination, she was afebrile, tachypneic (22 breaths/min), tachycardic (102 beats/min) and hypoxic (85% on room air). Imaging studies showed diffuse bilateral ground glass opacities (Fig. 1a) with septal thickening and non-specific ill-defined nodules. The patient was placed on high flow oxygen therapy, cultured and started on empiric antibiotic therapy. Bronchoscopy with lavage failed to reveal any infectious etiology. Histopathologic examination showed lymphocytic infiltration of the bronchial wall and the interstitium with expansion of the alveolar septa (Fig. 1b and 1c) suggestive of LIP. Patient was started on steroid therapy. Due to frequent association of LIP with autoimmune and rheumatologic disorders, further serologic testing was performed. The patient was found to be HIV positive, requiring antiretroviral therapy leading to rapid improvement in her symptoms.