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We report the case of a patient who presents subacute onset of interstitial pneumonia with rapidly progressive respiratory failure, sepsis and acute thrombotic complication. The diagnosis of the underlying pathology, the HIV infection, is made at the fifth day of hospitalisation, while the BAL allows also the detection of Pneumocistis jiroveci and CMV. Here we discuss the importance of an early diagnosis and the management of antibiotic and antithrombotic therapy in this kind of patients.