Bilateral pulmonary nodules in an immunocompromised host may offer a diagnostic dilemma. We present a case of a human immunodeficiency virus positive patient with history of intravenous drug abuse (IVDA) who was incidentally found to have bilateral multiple pulmonary nodules. She was diagnosed as having nodular pulmonary amyloidosis, presumably serum amyloid A derived (AA) in origin but confirmed not to be of amyloid light chain derived origin (AL), histologically associated with focal birefringent material and foreign body giant cell reaction, probably due to IVDA. Asymptomatic multiple pulmonary nodules in amyloidosis are usually of AL origin; however, recently similar changes have been found in the AA form in patients with Sjögren's syndrome or Crohn's disease. It has not been previously described in association with IVDA. Thus, this case documents a unique cause of bilateral pulmonary nodules due to amyloidosis consequent to IVDA.