Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical clinical worsening of a known condition, or the appearance of a new one, after initiating combination antiretroviral treatment (cART) in HIV-infected patients. A young Moroccan man was referred to our hospital after newly diagnosed HIV infection. After ruling out any active opportunistic infection, cART was started, but two weeks later the patient developed high fever unresponsive to medication. With clinical, imaging and laboratory tests, we noticed a rapid dissemination of tuberculosis (TB) with multiple organ involvement. These features were compatible with unmasking TB-IRIS. During hospitalization the patient received the TB treatment with poor improvement.