A 25-year-old male presented with profound hypoxemia despite use of a non-rebreather mask during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Chest X-ray showed a large right pneumothorax and extensive interstitial disease (Figure 1a). Hypoxemia continued despite chest tube placement, necessitating emergent intubation. Computed tomography (CT) of the chest (Figure 1b–d) was obtained and nasopharyngeal SARS-CoV-2 PCR was positive. HIV serology was positive and his absolute CD4+ count was 32 cells/mm3.