A rare case of abdominal tuberculosis (TB) presents as Hernial Sac Tubercles with Immune Reconstitution Inflammatory Syndrome (IRIS) in a HIV patient on Highly Active Antiretroviral Therapy (HAART). It is an accidental finding while opening an indirect inguinal sac during Hernioplasty, excision of the excess sac done. This is the first case report to our Knowledge as HIV-TB IRIS primary presentation as hernia sac tubercles.