A case of Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome presented radiographically with upper lobe cavitation and association pleural thickening, mimicking granulomatous lung disease. The patient was diagnosed in our institution with transbronchial biopsies which showed P carinii organisms and foamy eosinophilic debris in the alveolar spaces. Clinical and radiographic resolution occurred with trimethoprim sulfamethoxazole therapy. This particular radiographic pattern has not been previously reported in the literature.