A 39 year old male patient presented with complaints of sudden onset diminished vision in the right eye since two weeks and in the left eye since four days associated with painful ocular movements. On examination patient had optic disc edema in the right eye and the left eye showed optic disc pallor. Patient was also suffering from human immunodeficiency virus (HIV) infection. In this case study we report that the patient had pseudo Foster Kennedy syndrome directly attributed to HIV. Patient was started on intravenous steroids and responded with the improvement in vision in the right eye. Pseudo foster kennedy syndrome is a very rare disease and HIV as a predisposing factor is even more uncommon . It is important to rule out the opportunistic infections which occur in an HIV positive patient. Steroids have been found to be effective in improving the visual outcome and decreasing the morbidity in such patients. In 1911, Foster kennedy published six cases in which he demonstrated ipsilateral optic atrophy with contralateral papilledema due to expanding frontal lobe lesions. These signs were pathognomic for space occupying lesion in the region of basofrontal area on the side of the optic atrophy. 1In 1916, Foster kennedy published a paper in which he added ipsilateral anosmia to his previously described signs. 2 The Foster Kennedy syndrome then became a triad consisting of ipsilateral optic atrophy, contralateral disc edema, and ipsilateral anosmia. This syndrome is due to optic nerve compression, olfactory nerve compression, and increased intracranial pressure (ICP) secondary to a space occupying lesion (such as meningioma or plasmacytoma, usually an olfactory groove meningioma). Pseudo foster kennedy syndrome is defined as one-sided optic atrophy with papilledema in the other eye but with the absence of a space occupying lesion.3 HIV infection as a direct cause of optic neuropathy has been postulated. It is an uncommon presentation and a diagnosis of exclusion, with only a few case reports and case series in the literature. In our case also no cause for the asymmetric optic nerve involvement could be found besides the direct effect from the HIV virus. Our case had a rare presentation of pseudo-Foster Kennedy syndrome in a HIV positive patient. A Thirty nine years old male patient presented with complaints of sudden onset defective vision in the right eye since two weeks and in the left eye since four days associated with painful ocular movements. Patient was diagnosed with HIV in 2010 and was on anti-retro viral treatment since then with no other systemic illness. On examination the best corrected visual acuity (BCVA) was 1/60 in both eyes. On ocular examination in both eyes the pupils showed afferent pupillary defect. Fundus examination showed disc edema in the right eye (Figure 1) and in the left eye there was disc pallor (Figure 2). MRI of brain (flair, DWI, constrast) showed left optic atrophy and there was no evidence of demyelination, space occupying lesion, infection in the brain parenchyma. Total leucocyt...