A 38-year-old African American, HIV-positive man (CD4 count, 347 cells/ml; viral load, 633,000 copies/ml), having never received highly active antiretroviral therapy, presented with several months of nonproductive cough. He had no other past medical history. Computed tomography of the chest ( Figure 1) demonstrated innumerable miliary nodules. Bronchoalveolar lavage (BAL) was performed and contained 71% neutrophils, 13% lymphocytes, and 12% alveolar macrophages. Flow cytometry was not performed. Bacterial, acid-fast bacilli, and fungal smears were negative, and no organisms grew on culture. Pneumocystis carinii pneumonia direct fluorescence antibody and respiratory virus polymerase chain reaction were also negative. An open-lung biopsy specimen stained with hematoxylin and eosin (Figure 2; Figure E1 in the online supplement) showed hyperplastic peribronchovascular lymphoid follicles, follicular bronchiolitis. Bacterial, acid-fast bacilli, and fungal cultures of the biopsy specimen were without growth.