This report of disseminated pneumocystosis in an HIV-infected patient describes an unusual presentation consisting of splenic disease mimicking lymphoma, absence of typical roentgenographic signs of pulmonary or disseminated pneumocystis, and absence of use of aerosolized pentamidine. Because of these factors, a diagnosis of disseminated pneumocystosis was not considered. Our case in combination with other recent reports emphasizes the need to consider disseminated pneumocystosis in HIV- infected patients, even if they have no obvious pulmonary disease and have not received aerosolized pentamidine therapy. Timely recognition of this lethal infection is important for initiation of potentially curative therapy. © 1994 Southern Medical Association.