Introduction Human Immunodeficiency Viruses (HIV) commonly presented with acute seroconversion symptoms or opportunistic infections from immunosuppression, but first presentation of HIV with pulmonary embolism associated with active Pneumocystis pneumonia (PCP) is very rare. Case presentation A 28-year-old man presented with history of fever and cough associated with dyspnoea over 8 weeks and gradually worsen till maximised 2 week prior to admission. he did not improved inspite of antibiotics for suspected pneumonia. Found to be HIV positive with opportunistic infection. Computed Tomography Pulmonary Angiogram (CTPA) confirmed the presence of pulmonary embolism. He was treated successfully with anticoagulants, steroids, and antibiotics . discharged on base of clinical and radiological improvement. Conclusion Pulmonary embolism can be the first presentation of a newly diagnosed with HIV patient. The similar features of both viral pneumonia and subacute pulmonary embolism can lead to delay diagnosis, especially in the era of covid-19 pandemic infection

Keywords : Dyspnoea, HIV, Immunosuppression, Pneumocystis pneumonia, Pulmonary embolism.