Since the use of Highly Active Antiretroviral Therapy (HAART) for HIV infection, there have been increasing reports of systemic manifestations of immune restoration. This new clinical syndrome among HIV-infected patients is associated with underlying co-infections with mycobacteria, cytomegalovirus, hepatitis B and C infections, etc.... We report on an HIV/tuberculosis (TB) co-infected patient who developed an immune restoration inflammatory syndrome after initiation of HAART and anti-TB treatment. She developed fever, large abscesses and pleural and peritoneal effusions. Systemic symptoms decreased during corticosteroid treatment, but abscesses only disappeared 8 months after the start of the anti-TB treatment.