A forty-one year old African American male with a history of HIV infection was arrested and sent to jail for his offense. He was previously diagnosed with HIV in 2005. He had a history of non-compliance with his highly active antiretroviral therapy (HAART) and was currently not on any medications. He was screened at the correctional facility for complaints of fever, night sweats, cough and undocumented weight loss for the past four weeks. The laboratory studies demonstrated a white blood cell count of 3.73 x 103/mm3, normal liver function profile, CD4 count of 130/mm3 and viral load of >500,000 copies/ml. The chest x-ray obtained was normal. The patient's T-SPOT.TB (Oxford Immunotec Inc, Marlborough, MA; TST), an Interferon Gamma Release Assay (IGRA) test, performed a year ago, was positive. Unfortunately, no further evaluation was done by the primary physician at the time. The sputum collected during the current work up was smear-negative, but the PCR-based analyses with the GeneXPERT MTB/RIF assay detected M. tuberculosis in the specimen and showed no rifampicin (RIF) resistance. The patient was initiated on four drug anti-tuberculous therapy with isoniazid (INH), rifampin (RIF), ethambutol (EMB) and pyrazinamide (PZA). The sputum culture grew M. tuberculosis after four weeks of incubation and sensitivities showed the organism to be susceptible to all the aforementioned primary anti-tuberculous drugs.