Immune reconstitution inflammatory syndrome (IRIS) has been widely reported in patients with recognized and unrecognized opportunistic infections who are started on antiretroviral therapy (ART). It has most commonly been seen in association with mycobacterial infections, particularly Mycobacterium tuberculosis infections (Lawn et al. Lancet Infect Dis. 2005;5:361-373). Pulmonary and lymphatic IRIS has been well documented in HIV and tuberculosis (TB) coinfected patients receiving anti-TB therapy who are started on ART. However, intra-abdominal IRIS in these individuals has been less frequently been reported. We report an unusual case of pulmonary and hepatosplenic IRIS presenting in an HIV-infected patient restarting ART while being treated for TB.