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Endobronchial granuloma is a rare manifestation of endobronchial tuberculosis (TB). This case report describes a patient with endobronchial granuloma due to contiguous extension of granulomatous mediastinal lymph node inflammation, occurring following commencement of highly active anti-retroviral therapy in an HIV-positive man. Bronchoscopic findings mirrored CT imaging of endobronchial involvement of sub-carinal lymphadenopathy. Microbiologic studies were negative for acid-fast bacilli, fungal elements and malignancy. Mycobacterial and fungal culture as well as PCR for TB were all negative. Empiric anti-tuberculous therapy was commenced with complete resolution of symptoms. Immune reconstitution syndrome with development of active TB is common in patients commencing highly active retroviral therapy. Lymphadenitis is the commonest manifestation of this, and 20% of patients are culture negative for mycobacteria. Endobronchial granulomata due to TB are rare and no specific endobronchial therapy is required in such disease.