A 46 year old Zambian woman was referred from another hospital with a 4 week history of fevers, night sweats, vomiting, diarrhoea, and renal impairment. She had been diagnosed HIV positive in 2005, and started on HAART one year later. She had previously been treated for Herpes simplex virus infection, Cytomegalovirus pneumonitis, and Pneumocystis jirovecii pneumonia (PCP). At referral her blood CD4 count was 480 × 10 6 / L (range in HIV negative populations, 400-1500 × 10 6 / L); and she had an undetectable plasma HIV load. On arrival at our centre, she was confused, and had obvious pitting oedema of both lower limbs, widespread lymphadenopathy, and hepato-splenomegaly. Investigations (Table 1) revealed anaemia, leucocytosis, thrombocytopaenia, and acute renal and liver dysfunction.