A 41-year-old man, a native from Rio de Janeiro and an HIV and HCV carrier, without criteria for the treatment for HCV (detectable viral load, without cirrhosis and with normal transaminase levels), who had abandoned ART, had attended the Gaffree and Guinle University Hospital's immunology clinic complaining about continuous epigastric burning pain without irradiation and with diffuse abdominal pain that was mild and continuous, which had started approximately two months prior to admission. He also complained about intense hematochezia that had started three weeks before, with intense flow and with "pure blood" appearance without clots. He presented with daily hyperthermia since the abdominal symptoms had started with intermittent high fever and an over 10% body weight loss in the same period. The physical examination revealed oral candidiasis, bleached mucous membranes, and cachexia. At the admission time, the HIV viral load was recorded at 905,569 copies per ml, and the TCD4 lymphocyte count was 144 cells/dL. Prophylactic sulfamethoxazole-trimethoprim 400/80 mg 2 IV ampoules once daily and fluconazole 200 mg IV once daily for treatment of the oral candidiasis were prescribed. The patient's condition evolved without major occurrences or complaints, presented with high fever, above 38 C almost every day. Blood counts revealed thrombocytopenia, neutrophilia, lymphopenia, anemia, microcytosis, and anisocytosis (Table 1). The medical team requested upper digestive endoscopy (Figure 1) and colonoscopy (Figure 2), which verified the presence of ulcer with irregular and raised edges, fibrinonecrotic base, measuring approximately 3 cm in the middle third of the esophagus and 30 cm from the incisors and the mild antrum gastritis, and swollen, irregular, and fibrinous ulcers in the ileocecal valve, descending colon, and all other segments. The lesions were similar to those found in the esophagus, which could suggest the same etiology. It was suggested by the internal medicine team that the diagnosis could be a coinfection (tuberculosis, cytomegalovirus, and herpes simplex virus disease). The diagnosis of tuberculosis and cytomegalovirus coinfection of the gastrointestinal tract was confirmed by the histopathological report (Ziehl-Neelsen staining of acid-fast bacilli, CMV intracytoplasmic inclusions in Giemsa staining, and immunohistochemical study with positive labeling for CMV in cells with clear halos), and some time later, culture with the growth of M. tuberculosis (Figure 3). Treatment was started with an RIPE scheme (rifampicin + isoniazid + pyrazinamide + ethambutol) 4 tablets daily and ganciclovir 350 mg IV for 21 days with a weight gain of 4 kg and clinical and laboratory improvement. He was discharged from the hospital with ART lamivudine, tenofovir, and efavirenz (TDF + 3TC + EFV) one tablet per day and was referred to a clinical follow-up for tuberculosis and HIV/HCV coinfection monitoring. At the end of the treatment for tuberculosis and 6 months after ART was restarted, the patient's viral load was <40 copies/dL and the CD4+ T-cell count was 356 cells/dL, asymptomatic.