Despite extraordinary recent advances in the management of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome, patients infected with HIV are still susceptible to a variety of complications that stem either from immunodeficiency or from side effects of antiretroviral regimens. Diagnosis is often challenging, since every organ in the body can be affected by HIV, and the kidneys have been increasingly shown to be involved by a variety of disease processes. Opportunistic infections including those caused by atypical organisms, malignancies such as lymphoma and Kaposi sarcoma, and disease processes specific to HIV infection such as HIV-associated nephropathy have all been shown to affect the kidneys. In this era of highly active antiretroviral therapy (HAART), renal disease arising secondary to antiretroviral medication has been added to the list. Furthermore, the introduction of HAART has increased survival of HIV-infected patients; consequently, the frequency of HIV-associated and incidental renal disease is expected to rise in this population. Because mortality and morbidity rates are affected by the early recognition of renal disease in HIV-infected patients, it is paramount that the radiologist be familiar with the imaging features that can be encountered in such cases.

An HIV-1-infected adult presented with a short history of dyspnoea, productive cough and myalgia with fever. Shortly after presentation, he developed the abrupt onset of high-volume watery diarrhoea: stool culture grew Shigella sonnei. At the same time, he became hypoxaemic, and thoracic imaging showed bilateral lower lobe consolidation/collapse. Culture of sputum and blood was negative. The patient recovered with fluid resuscitation and ciprofloxacin monotherapy. This is the first reported case of pneumonia complicating S. sonnei dysentery in an HIV-infected adult.

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