A 5 1/2-year-old HIV-infected boy presented with recurrent fever and cough since 2 years, recurrent diarrhea and vomiting since 6 months and generalized pruritis and abdominal pain since 15 days. He had taken ATT 2 years ago for 6 months. His father was a prisoner and was diagnosed to be HIV-infected 2 years back. His mother was also diagnosed to be HIV infected a year back. Thus, the child seemed to have acquired the HIV infection vertically. He was immunized till date. On examination, he was malnourished (weight=10 kg, <5th centile and height=96 cm, <5th centile). He had pallor, multiple mobile nontender cervical, axillary and inguinal lymphnodes with oral thrush. On systemic examination, he had mild splenomegaly. Other systems were normal. His investigations showed hemoglobin of 11.4 g/dl, white cell count of 7,200/mm3 and ESR of 62 mm at end of 1 h. X-ray chest showed bilateral hilar congestion. Mantoux test was negative. Liver function and renal function tests were normal. His enzyme-linked immunosorbent assay for HIV was repeated, which was positive. A baseline CD4 count of 161 cells/mm3 was detected, with a CD4 percentage of 7.98%, suggestive of severe immunosuppression. He was started on three drugs; ART consisting of Stavudine, Lamivudine and Efavirenz. He had a weight gain of 2 kg within 1 month of starting ART and his lymphadenopathy regressed. However, his cough and pruritis persisted. A repeat X-ray chest showed a right-sided lower zone pneumonia. A Mantoux test performed at this time was negative. He was treated with antibiotics but the pneumonia did not subside, and thus he was started on ATT to which the pneumonia responded. Three months after start of ATT, he developed left cervical matted rubbery lymphadenopathy (4 cmx4 cm) that did not subside with antibiotics. Fine needle aspiration of the cervical adenopathy was carried out, which showed caseous granulomas. Drug compliance with ATT was confirmed. A wedge biopsy of the node was carried out, which again confirmed tuberculosis, and then the child was started on six-drug ATT. Subsequently, within 1 week, he developed severe sepsis with intestinal obstruction and was hospitalized. CT of the abdomen and pelvis showed multiple splenic lesions, a large liver lesion, encasing retroperitoneal lymphnodes, large right pelvic lymphnodes and a large right inguinal lymphnode with a large presacral mass (6.8 cmx5.08 cm) with intrasacral extension into the spinal cord suggestive of lymphoma [Figure 2]. However, before any intervention could be started, the child expired the following day. A postmortem lymph node biopsy was performed, which showed round cell tumor that was found to be a B cell lymphoma on immunophenotyping.