Pulmonary infections and neoplasms are the most common chest manifestations in patients infected with the human immunodeficiency virus. A case of a young patient with a history of being a smoker and drug addict is presented, who presented with a wet cough, yellowish sputum, hemoptysis, easy fatigue, loss of appetite and weight loss, who was referred with a possible diagnosis of tuberculosis but after admission. he was diagnosed with HIV and advanced lung cancer. The diagnosis was made by fine needle puncture after which he presented a hemothorax as a complication, which caused his death.

Keywords: lung cancer, tuberculosis, HIV

Approximately 5 to 10% of patients with HIV require hospitalization in an intensive care unit (ICU), of which approximately 40% are unaware that they are infected with this virus and it is estimated that 50% do not receive retroviral treatment. upon your admission [8]. The patient described above was unaware that he had HIV, never received retroviral treatment and while hospitalized his symptoms worsened requiring admission to the ICU.

Bacterial pneumonia, especially that caused by pneumococcus, followed by pneumonia by Pneumocystis jiroveci and tuberculosis, is the most frequent cause of admission to health facilities in patients with HIV, with a higher incidence in the young male population [9]. In pulmonary tuberculosis, symptoms such as cough and expectoration are described, which can be accompanied by mild hemoptysis [10], in lung cancer, persistent cough, chest pain, hemoptysis, dyspnea, rhonchi are also described as the most common symptoms. and wheezing, fatigue and dysphonia [11]. In this case, the patient was diagnosed with lung cancer, a pathology that is not very common in a young patient, who was initially mistaken for pulmonary tuberculosis, due to presenting symptoms compatible with this disease, such as wet cough, hemoptysis, and weight loss, together with a history of drug addiction.

Although of varied etiology, smoking is recognized as the main cause of lung cancer, accounting for 90% of all cases [11]. This patient had a history of being a smoker since he was 17 years old, so he had been smoking for around 25 years, a factor that could have contributed to the development of his disease.

Lymphoma and Kaposi's sarcoma are the most frequent lung cancers in patients with HIV [6], however, in this patient a moderately differentiated Squamous Cell Carcinoma was diagnosed, a pathology that is not very frequent in this type of patient.

Different modalities are available for the diagnosis of this disease: radiology, bronchoscopy, bronchial biopsy, sputum cytology, bronchial brushing, bronchial lavage, and fine needle aspiration cytology [12]. In this case, the positive diagnosis was made by fine needle biopsy.

Only 20% of cases have localized disease, 25% have it spread to regional lymph nodes, and 55% already suffer from distant metastases. Once diagnosed, they have a very poor prognosis, since only 15% of cases can be cured [13]. This patient came in an advanced stage of his disease, presenting lymph node and liver metastases. After the diagnosis was made, he suffered a hemorrhagic complication (hemothorax) that ended the patient's life.