To analyze a case with tuberculous meningitis complicated with paradoxical reaction, and to raise the attention to tuberculous meningitis complicated with paradoxical reaction.

The clinical data, diagnosis and treatment process and prognosis of a patient with tuberculous meningitis complicated with paradoxical reaction admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences on September 8th 2020 were analyzed, retrospectively.

The patient presented clinically with headache and fever, the cerebrospinal fluid examination showed that the intracranial pressure was significantly increased, the white blood cells and protein level were high, and the chlorine level was low. Mycobacterium tuberculosis infection of T cells spot test were positive both in peripheral blood and cerebrospinal fluid, brain Magnetic Resonance Imaging (MRI) showed multiple abnormal signals, while the rest of the etiological examination was negative. The patient was considered tuberculous meningitis and started diagnostic anti-tuberculosis treatment. The clinical symptoms and cerebrospinal fluid tests improved for a while, but the condition deteriorated again after the reduction of glucocorticoids. The patient was considered paradoxical reaction. After increased doses of glucocorticoid, the patient improved rapidly. MRI at 1 year was essentially unremarkable.

Tuberculous meningitis complicated with paradoxical reaction is rare, which is easy to be misdiagnosed and delayed to receive treatment. Therefore, clinicians are reminded to be alert to tuberculous meningitis complicated by paradoxical reaction for patient with aggravation of the disease after anti-tuberculosis treatment, high-dose glucocorticoids is the preferred treatment.