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Paradoxical tuberculosis – immune reconstitution syndrome (pTB-IRIS) is a well-recognized cause of clinical deterioration in HIV tuberculosis (HIV-TB) co-infected individuals following initiation of antiretroviral therapy (ART). Here, we present a rare presentation of pTB-IRIS which manifested as a prostatic abscess in a case of HIV positive patient. To the best of our knowledge this is the first reported case of pTB-IRIS reported in literature which manifested as a prostatic abscess. Paradoxical TB-IRIS manifesting as prostatic abscess is extremely rare and a high index of clinical suspicion is needed to diagnose and appropriately treat it.