A 32 year old homosexual Indian man who was positive for HIV (CD4 cell count 416×10⁶/L, HIV-1 RNA 64 000 copies/mL) presented to his HIV doctor with a two month history of dizziness and 7 kg weight loss. He felt unsteady on walking but denied true vertigo, falls, visual disturbance, or loss of consciousness. He reported loss of eyebrow hair and an itchy rash. HIV-1 positivity had been identified four years previously, but he had not had any HIV related illnesses and took no drugs. He had not received antiretroviral drugs because his CD4 cell count was greater than the 350×10⁶/L threshold below which current UK guidelines recommend treatment for HIV.1 Examination showed an ataxic gait with negative rombergism, but otherwise normal neurology. A generalised scaly maculopapular eruption including the palms, soles, and genitalia and loss of eyebrow hair were seen. Three irregular ulcers were visible on the hard palate.