A 37-year old housewife was commenced HAART-(Emtricitabine/Tenofovir/Nevirapine) after 1year progressive weight loss and recurrent diarrhoea, without fever or cough or radiological features of pulmonary tuberculosis. Four weeks after regular HAART, she presented with non-productive cough, breathlessness, fever and progressive painful bilateral inflammatory cervical adenopathies. Chest examination was normal. A repeat chest X-ray however, revealed features suggestive of perihilar adenopathies. Histology of biopsied cervical node confirmed tuberculosis-(TB) granuloma. A diagnosis of disseminated TB-(lungs and nodes) secondary to IRIS was made. A full blood count revealed a packed cell volume of 28% and total white cell count of 2.9 X 103/l, with predominant neutrophils (52%) and lymphocytes (40%). Renal and liver function tests were normal. Standard combination anti-TB drugs by DOTS were commenced along with tablets prednisolone 40mg daily (tapered). Her HAART regimen was continued but Nevirapine was switched for Efavirenz to avoid drug interactions. All symptoms gradually resolved and by the 3rd month on HAART, her CD4 cell count had increased from 15cells/ul to 163cells/ul.