A paradoxical response in tuberculosis is defined as clinical and radiological worsening of previous lesions or development of new lesions after initial improvement during the process of anti-tuberculous treatment. The authors report on a patient who developed massive pleural effusion as a paradoxical response after 8 weeks of anti-tuberculous treatment. The patient’s symptoms were improved with thoracostomy without any change of anti-tuberculous medications. If symptoms worsen during the process of anti-tuberculous treatment, drug resistance, non-compliance, or other diseases should be excluded first. If it is regarded as a paradoxical response, the treatment plan need not be changed except for additional conservative treatment.

• 이승준(분당제생병원 소아청소년과) | Seung Joon Lee
• 차민아(분당제생병원 소아청소년과) | Min A Cha
• 우열륜(분당제생병원 소아청소년과) | Yeol Ryoon Woo
• 김현진(분당제생병원 소아청소년과) | Hyun Jin Kim
• 안연화(분당제생병원 소아청소년과) | Yeon Hwa Ahn Corresponding author