A case of hypertrophic pulmonary osteoarthropathy (HPOA) in a HIV-infected patient with granulomatous Pneumocystis carinii pneumonia is described. This is the third case of HPOA associated with AIDS reported in the literature. Granulomatous P. carinii pneumonia is an unusual manifestation of P. carinii infection. Surgical treatment of this condition may lead to the dramatic spread of P. carinii causing a fulminant course with fatal outcome.