In our patient, the clinical presentation was consistent with a systemic illness with a large inflammatory/infective component. The patient was originally from a country with endemic mycobacterial and fungal infection. Investigations therefore were undertaken to exclude a variety of possible causes -including disseminated mycobacterial and fungal disease, as well as lymphomalike conditions, such as MCD. Prompt diagnosis was made following lymph node biopsy. The decision to biopsy an inguinal lymph mode, rather than a cervical node was based on the clinical findings of a large and easily palpable inguinal lymph node mass. Although small volume bilateral cervical lymphadenopathy was present, this was far less clearly abnormal than the groin lymph nodes. A particular issue in HIV patients is the presence of persistent generalised lymphadenopathy, which represents an immune response directed against HIV. This typically results in findings similar to the cervical adenopathy present in this patient; and therefore neck biopsy may have in fact slowed the diagnostic process. Antiretroviral therapy was continued, but modified on the ICU. Notably the patient had been using antiretroviral therapy (HAART) for two years prior to her presentation to our service. She had had a persistently undetectable plasma HIV load (<50 copies/mL). Her nucleoside reverse transcriptase inhibitors (abacavir and lamivudine) were stopped because of their association with lactic acidosis and hepatic steatosis. Although it would be surprising for this to occur after such a prolonged time on these drugs, it was important to minimise any possible mitochondrial toxicity that might have resulted from these agents; and which in turn could have contributed to acidosis. Monotherapy with ritonavir-boosted protease inhibitors is a useful treatment option in patients who are intolerant or resistant to other agents [8] . The approach is particularly successful in patients who have already suppressed their plasma HIV load, such as in this case.