CASE PRESENTATION: A 56-year-old non-smoker male, with recently diagnosed AIDs/HIV infection presented with worsening shortness of breath, dry cough and generalized malaise for 1 week. He was started on antiretroviral therapy about 4 weeks prior to his presentation. He was hemodynamically stable on examination. He appeared wellnourished without any peripheral lymphadenopathy. Physical examination revealed bilaterally scattered crepitations. Laboratory data failed to reveal any abnormality. His CD4 cell count prior to starting antiretroviral therapy was 456 cells/uL, which increased to 730 cells/uL over aperiod of 4 weeks. Imaging studies showed multiple bilateral pulmonary nodules without any evidence of cavitation (Fig. 1a) and hilar lymphadenopathy. He was started on broad spectrum antibiotics. Bronchoscopy with bronchoalveolar lavage failed to reveal any infectious etiology. Due to high suspicion for malignancy a transbronchial needle aspiration of the hilar lymphadenopathy as well as an open lung biopsy were performed. Histopathologic examination of the biopsies showed non-necrotizing granulomas (Fig. 1b) with negative stains for fungus and acid fast bacilli. Serum and urine fungal serologies were negative. The patient had elevated angiotensin converting enzyme levels (83 U/L). He was evaluated for extra-pulmonary involvement of sarcoidosis. Following a negative work up he was started on steroid therapy, after which he showed resolution of his symptoms and imaging findings.