Highly active antiretroviral therapy (HAART) slows the progression of human immunodeficiency virus (HIV) disease and partly restores immune function.1 Unfortunately, this reconstitution of immune function may produce increased inflammation and clinical disease at previously occult sites of mycobacterial or viral infection. This new phenomenon has been called syndrome of immune reactivation.2-5 We describe a patient with advanced HIV disease who developed a cutaneous ulcer due to Mycobacterium avium and recurrent genital herpes 1 month after commencing HAART.