Interpretation: Enlarged abdominal lymph nodes in a HIV-positive African patient with low CD4 counts are suggestive of abdominal TB. A chest X-ray should be done as the majority of patients with abdominal TB also have pulmonary changes suggestive of the disease . If TB prevalence in the patient population is high, we would recommend starting TB treatment on clinical and imaging data. We recommend attempting to perform a follow up US after 6 to 8 weeks. In settings with lower prevalence and in cases of persistent lymphadenopathy, US-guided aspiration should be attempted. The aspirated lymph node material is sent for acid-fast stain (which is frequently positive), TB culture, and histology. In cases of persistent lymph nodes despite TB treatment, multi-drug resistant TB needs to be considered as well as other causes of persistent lymphadenopathy (especially lymphoma, KS, and non-TB mycobacterial infection). Non-compliance in taking the medication should be evaluated. It has to be noted that patients receiving TB treatment, and in particular when receiving concomitant ART, may show a initial increase of the size of the nodes due to immune reconstitution inflammatory syndrome . This should not result in cessation of ART as it usually subsides during continued treatment.