We report a case of a 56-year-old man with a long-term history of intravenous drug use who presented with 5-month history of cough and recurrent pneumonia. Except chronic HIV and hepatitis C virus (HCV) infections there was no other significant medical history and no recollection of any foreign body aspiration. Repeated chest X-ray in many medical institutions showed only typical mild recurrent inflammatory changes in the right lower lobe. Using a flexible bronchoscopes we found and removed the injection needle. We observed rapid recovery and the patient was discharged from hospital 5 days later in good condition. Foreign body aspiration is rarely the cause of pneumonia and most often occurs in children. In patients infected with HIV due to immunodeficiency, with high risk of opportunistic infections and other AIDS-defining illnesses, iatrogenic etiology of lung pathology is rarely taken into account. Although the aspiration of a foreign body rarely causes recurrent pneumonia, in intravenous drug-dependent patients, it should be considered in the differential diagnosis, even if the results of repeated chest X-rays are negative. Radiography is the best method for the imaging of metallic foreign bodies. However, foreign bodies that retain X-ray radiation are detected in only approximately 25% of patients who have inhaled an object.