Case of a 33-year-old female with AIDS who presented with fevers, chills, lower back pain and a large right hilar mass. Biopsy of the right paratracheal nodes revealed poorly differentiated non-small cell carcinoma with extensive necrosis. In patients infected with HIV the incidence of primary lung carcinoma is unknown. Despite these uncertainties, primary lung carcinoma must be considered in the differential diagnosis of young HIV-infected individuals presenting with intrathoracic radiographic abnormalities.