Bronchiolitis obliterans with organising pneumonia is a  very rare presentation of HIV.  Pathologically it is characterised by formation of granulation tissue in bronchiolar lumen. Clinicaly, there is persistent non productive cough, dyspnoea, reduced vital capacity and weight loss. The imaging features mimic those of bacterial infections, Pneumocystis carinii, TB or heart failure.Radiological findings are non specific and include bilateral diffuse alveolar infiltrates in x ray and CT scan. But there are no clinical signs of infection. Blood , sputum and bronchoalveolar lavage are normal. Biopsy is essential for confirming the diagnosis. It is a potentially curable disease, with steroids. Toxic fumes, immunodeficiency, infection, connective tissue disorders, myelodysplastic syndrome and radiation therapy are other causes.