<b>Introduction:</b> Miliary pattern in VIH patients is tipically secondary to tuberculosis. Nonetheless, variations are observed depending on the degree of immunossuppresion. Different organisms present with this pattern including virus or fungi which is why with this pattern, complementary studies should be done for a precise diagnosis. <b>Case:</b> We present the case of an HIV-infected 22 year old male without antiretroviral treatment who presented with 10 days of fever without other symptoms and a pulmonary miliary pattern. Complementary studies included CD4 of 68 cells, chest CT scan with generalized micronodules, bronchoalveolar lavage with <i>P. jirovecci</i> cysts and transbronchial lung biopsies with organizing pneumonia. Therapy with trimethoprim/sulfamethoxazole was started with partial response; open lung biopsy showed non-caseating granulomas. We obtained a positive culture as well as a positive urinary antigen for <i>H. capsulatum</i> so IV amphotericin was given for 2 weeks with good clinical response. <b>Conclusion:</b> Presentation of disseminated histoplasmosis with pulmonary compromise may include a miliary pattern. However, <i>P. jirovecci</i> is tipically known for presenting with ground glass opacity with atypical manifestations which include miliary pattern with granulomas as first described by <i>Wasser et al</i> in 1989 in a similar patient, with posterior reports in transplants subjects.