Pulmonary infection by Pneumocystis carinii in patients with acquired immunodeficiency syndrome (AIDS) can result in different radiological patterns with an ever expanding spectrum. A 40-year-old male, infected with the human immunodeficiency virus (HIV), presented with toxic symptoms and multiple pulmonary cystic lesions in the context of a Pneumocystis carinii pneumonia. The rarity of this radiological presentation is discussed and literature is reviewed. In addition, the possible pathogenetic mechanisms are discussed, and emphasis is made on the need for higher suspicion index in similar presentations in patients at risk of HIV infection.

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