A 19-years old HIV-1 infected female student was commenced HAART-(Tenofovir/Emtricitabine/Efavirenz) and empirical anti-TB drugs on account of eight months history of recurrent fever and weight loss, and one month history of cough with haemopytsis. After three months on regular HAART and three weeks on anti-TB drugs, she developed papulonodular discoloured skin lesions associated with oedema (Figure 2), painful generalised lymphadenopathies and worsening cough and breathlessness. On chest examination she was severely breathless with wide spread coarse crepitations in both lung fields. Other systemic examinations were not remarkable. While on HAART her CD4 cell count had increased from 172cells/ul to 297cells/ul. At presentation, her packed cell volume was 32% and total white cell count was 4.5 X 103/L, with predominant neutrophils (63%) and lymphocytes (26.4%). Sputum microscopy and cytology were negative for AFB and malignant cells respectively. Chest X-ray showed diffuse bilateral alveolar opacities with obliteration of cardiac borders. Skin biopsy confirmed Kaposi's sarcoma but histology of nodal fine needle aspirates revealed non-specific chronic inflammation. A diagnosis of disseminated Kaposi's sarcoma (Skin, nodes, lungs) secondary to IRIS was made. Her previous HAART regimen was continued and anti-tuberculosis drugs were stopped since symptoms did not improve after 2 months of therapy. While being worked up for systemic chemotherapy, she was received tablets prednisolone 60mg daily (tapered), and tablets levofloxacin 500mg daily for empirical coverage of bacterial pneumonia. After an initial improvement, her condition rapidly deteriorated and she died shortly thereafter. Unfortunately, permission for post-mortem was denied on cultural grounds.