A 4-month-old boy without significant medical history presented with fever, labored breathing and desaturation. Chest radiograph (CXR) revealed bilateral ground-glass opacities with air bronchograms (Fig. 1). High-resolution CT (HRCT) showed diffuse, bilateral, ground-glass airspace opacities with interlobar septal thickening (Fig. 2). The patient was later diagnosed with hypogammaglobulinemia caused by CD40 ligand deficiency and Pneumocystis carinii pneumonia (PCP) when the direct fluorescent antibody stain for PCP was positive.