A 40-year-old HIV-positive male patient on HAART and anti-tuberculosis medication presented with 3-week history of loss of balance, dizziness and difficulty in speaking. On examination, he had ataxia, nystagmus, dysmetria and dysdiadocokinesis. His CD4 count was 167 cells/microL. MRI showed high-signal on T2-weighted and FLAIR images bilaterally in the cerebellar hemispheres with the right more involved compared with the left (Figure 3). The lesions did not demonstrate any restricted diffusion or enhancement post contrast. The CSF was not active and demonstrated no growth. The patient's anti-tuberculosis medication was continued, and the HAART was optimised. He was discharged to the rehabilitation unit.