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.