49-year-old African male with a history of acquired immunodeficiency syndrome (AIDS) and Kaposi sarcoma(KS)presentedwithnonproductivecough,shortnessof breath, and exercise intolerance. He first came to the United States in 1995 for treatment of infectious retinitis thought due to cytomegalovirus, which resulted in blindness. The patient subsequently tested positive for human immunodeficiency virus (HIV). In 1998 an oral mucosal lesion was biopsied and found to be KS. Several skin lesions typical for KS were also discovered at that time. The patient denied pulmonary symptoms, and a chest radiograph obtained at that time was normal. Before his current presentation, the patient’s CD4 count was 54 (normal adult range 500 to 1500 cells/cubic mL of blood) and he had an HIV viral load of 5444 (normal is 0; treatment should be considered for HIV-infected people who have viral loads higher than 30,000 copies per mL of blood using a test known as a branched DNA test, or more than 55,000 copies using an RT-PCR test). A new HIV drug regimen was begun, and after several months, the patient’s skin lesions improved. The patient then returned to Africa and due to socioeconomic reasons was noncompliant with all medications. He was lost to follow-up for 2 years until he presented with his current complaint of nonproductive cough and shortness of breath. On his current admission a chest radiograph (Fig. 1A and B) revealed coarse, ill-defined opacities in the perihilar regions and lower lobes, with areas of nodularity. A small left pleural effusion and interlobular septal thickening (Kerley B lines) in the right lung base were also noted. A computed tomography (CT) scan of the chest (Fig. 1C and D) showed nodular thickening of the bronchovascular bundles, flameshaped opacities in a bronchovascular distribution, and confluence of nodular opacities in the lower lobes forming illdefinedmasses.Interlobularseptalthickening,smallbilateral pleural effusions, and axillary lymphadenopathy were also seen. Thepatientsubsequentlyunderwentbronchoscopywhich showed scattered, raised, erythematous, friable lesions throughout the tracheobronchial tree. Bronchoalveolar lavage was performed which revealed no infectious organisms on Gram stain or culture. A CT scan of the patient’s abdomen and pelvis (not shown) showed multiple lytic osseous lesions, which were proven to be Kaposi sarcoma by CTguided bone biopsy. An endoscopic examination performed because of upper gastrointestinal bleeding revealed Kaposi sarcoma involving the duodenum.