Chest X-ray of a 7-years old girl with perinatal HIV infection, followed by recurrent pulmonary tuberculosis and persistent high viral load associated with poor adherence to therapy for both HIV and tuberculosis.The image shows apical pleural thickening and cardiac silhoute not well defined due to heterogeneous opacities and centrilobular nodular pattern affecting the right medial and basal middle lobe, due to possible transbronchial dissemination from the left lung to the middle lobe of the right lung, suggesting a re-activation of tuberculosis. Left lung “destroyed” as a result of tuberculosis, in the upper lobe there are areas of emphysema and fibrosis, as well as consolidation of the lower lobe with cavitation (cavernous aspect) and bronchiectasis.