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Introduction: A paradoxical reaction (PR) after an appropriate initial response to tuberculostatic treatment should be considered in patients with worsened clinical and neuroimaging features. Our purpose was to present a case of a PR in the central nervous system (CNS) in an immunocompetent child.Casedescription: A previously healthy 15-year-old girl was admitted for a 30-dayhistory of right-hand tremor. MRI showed a gadolinium-enhancing mesencephalic lesion. Initial blood analyses were normal. Human immunodeficiency virus (HIV) infection and primary immunodeficiency diseases were ruled out. Chest radiography showed interstitial infiltrates. Bacilloscopy was positive. Miliarytuberculosis with CNS involvement was diagnosed and tuberculostatic (fourdrugs) and corticosteroid treatment was started.  At 8 weeks after treatment initiation, the patient worsened. Vision loss in the left eye (5/10) with normal fundoscopy, left III-cranial-nerve palsy, and right hemiparesis were observed. MRI showed supratentorial lesions and brainstem edema. Brain biopsy only revealed reactive gliosis. The girl was put on high-dose corticosteroids with a good clinical response and improved neuroimaging. Discussion: Data on PR reactions in neurotuberculosis in immunocompetent hosts are scarce, especiallyin children. A PR after tuberculostatic treatment is well known in HIV patients.The incidence in immunocompetent children is 10-14%. The most commonly reported  extrapulmonar involvement is inthe lymph node. Despite data on the poor prognosis of neurotuberculosis,outcome was excellent in our patient. Awareness of this entity is important, as modified management may be necessary in some cases.

paradoxical reaction; tuberculosis; children