Miliary tuberculosis (MiTb) refers to the hematogenous dissemination of Mycobacterium tuberculosis. Despite the diminution in tuberculosis (Tb) incidence, the proportion of MiTb cases has been seen to increase in the United States. A 55-year-old US citizen positive for human immunodeficiency virus living in Brazil was diagnosed with pulmonary Tb and treated with isoniazid, rifampin, and pyrazinamide. After 1 week of therapy, he traveled in a commercial flight to Puerto Rico. Several days after his flight, the patient was diagnosed at our institution with epididymo-orchitis, shoulder joint infection, and extensive pulmonary Tb. Four drug antituberculous therapy was started, followed by antiretroviral drugs. Clinical presentation worsened with the development of immune reconstitution syndrome which improved with systemic steroids. This case illustrates the ease with which potentially active tuberculous infectious subjects can travel and the uncommon presentations of MiTb such as joint and scrotal involvement.