Paradoxical CNS TB reactions are well described in HIVnegative patients, and include expanding intracranial tuberculomas, tuberculous meningitis, and spinal cord lesions [49] [50] [51] . TB-associated CNS IRIS has also been reported in HIV-positive patients [45, 46, 52] . Compared to non-CNS TB-IRIS, symptoms tend to occur later, usually 5-10 months after ART initiation [45, 50, 52] . Crump et al [45] described an HIV-seropositive patient in who developed cervical lymphadenopathy after five weeks of ART. Five months later, CNS symptoms associated with an expanding intracranial tuberculoma appeared after initiation of antituberculous therapy. The significant morbidity in this case illustrates the importance of maintaining a high clinical suspicion for the disease, particularly in endemic areas.