CASE PRESENTATION: A 36-year-old woman with a history of IV drug use, AIDS (CD4+ 1 cell/mm3, viral load 101,000 copies/mL, non-compliant with HAART), and HCV presented with one month of fatigue and productive cough and two weeks of fevers, night sweats, and shortness of breath. Initial laboratory evaluation revealed WBC 3 x 109/L and LDH 668 U/L (institutional ULN 225 U/L). She was started on broad-spectrum antibiotics, including PCP treatment and steroids. Bronchoscopy with BAL was non-diagnostic. Blood, fungal, and AFB cultures, as well as Aspergillus, Cryptococcus, Histoplasma, and Legionella antigens were negative. PCP cytology and influenza PCR were negative. Her condition worsened and she was intubated for hypoxia and septic shock. Repeat CT showed progressive multifocal pneumonia with peripherally distributed infiltrates. She developed severe ARDS and died. Autopsy revealed fulminant adenovirus infection in both lungs.