Paradoxical Reaction (PR) refers to clinical and/or radiological worsening of tuberculosis in a patient already receiving effective treatment, without alternative explanations such as drug resistance, intercurrent infection, or drug toxicity. PR is frequently reported in HIV-positive patients but can also occur under other conditions of immunosuppression, such as malnutrition. We present the case of a severely malnourished young woman with pulmonary tuberculosis who developed PR during antituberculosis therapy. The outcome was favorable following corticosteroid treatment and nutritional support. This case highlights the importance of recognizing PR as a potential therapeutic complication in immunosuppressed patients.
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