Abstract
In this case report, we present a 35-year-old homosexual man with advanced HIV disease and disseminated tuberculosis (TB) who developed paradoxical TB immune reconstitution inflammatory syndrome (IRIS). Corticosteroids, vital in life-threatening IRIS, were initiated, resulting in symptom resolution but unmasking AIDS-associated Kaposi's sarcoma (KS). Diagnostic confirmation revealed disseminated KS, necessitating a comprehensive therapeutic strategy involving chemotherapy and thalidomide as a steroid-sparing agent. This case underscores the complexity of managing advanced HIV disease with IRIS, emphasizing the cautious use of corticosteroids due to the potential risk of KS unmasking. The report contributes to the limited documentation of indigenous HIV-associated KS cases in India and highlights the need for vigilant monitoring and careful therapeutic decisions in this population.