A 38-year-old gentleman presented to us for fever and weight loss of two months duration. He had a significant background history of having multiple sex partners and had no other co-morbidities. His vitals were normal, systemic and general physical examinations were normal except for low body mass index (BMI) of 17.5 kg/m2. On subsequent evaluation, he was found to have acquired immune deficiency syndrome (AIDS) with cluster of differentiation 4 (CD4) cell count of 50 cells/mm3. He was started on highly active antiretroviral therapy (HAART) comprising of tenofovir, lamivudine, and efavirenz. His fever subsided with improvement in general well-being till one month back, when he again presented to us, this time with generalised lymphadenopathy and low-grade fever. On examination, he was febrile with the temperature of 100oF, had normal blood pressure (112/74 mmHg) with a heart rate of 96/min and respiratory rate of 18/min. He was malnourished with body mass index (BMI) of 18 kg/m2. General physical examination showed pallor with multiple, bilateral, cervical and inguinal lymphadenopathy. The lymph nodes were non-tender, mobile, firm in consistency and maximum 3x3 cm in size. Examination of the respiratory system, cardiovascular, per-abdominal and central nervous system were within normal limits. Complete blood count showed normocytic, normochromic anaemia (10.4 g/dl) with mild neutropenia (32x109/L) and normal platelet count (180x109/L). Chest X-ray showed miliary infiltration in bilateral lung fields. Lymph nodal biopsy showed spindle-shaped histiocytes, filled with acid-fast bacilli on Ziehl-Neelsen (ZN) stain, suggestive of MSP (figures 1A-1C). Immunohistochemical (IHC) stains were positive for CD68, S-100 and negative for CD31, which were consistent with MSP (figures 1D, 2A, and 2B). Polymerase chain reaction (PCR) of the biopsy tissue was positive for MTB. Subsequently, he underwent bone marrow biopsy, which also showed epitheloid granuloma suggestive of tubercular marrow infiltration. Hence, HAART was continued and anti-tubercular therapy (ATT) was started with isoniazid, rifampin, ethambutol, and pyrazinamide along with pyridoxine supplementation. Fever resolved 2 weeks after the initiation of ATT and there was a resolution of lymph nodal swelling by 6 weeks.