摘要Rationale: To report neurological paradox in a non-HIV patient with pulmonary tuberculosis. Patient concerns: A 26-year-old non-human immunodeficiency virus immunosuppressed female patient presented with diffused headache, diplopia, ascending paraparesis with loss of bowel and bladder control. Diagnosis: Disseminated neurological paradoxical reaction developed during tuberculosis treatment in a non-human immunodeficiency virus patient. Intervention: High-dose intravenous corticosteroid was added to the anti-tuberculous drugs, followed by tapered dose of oral prednisolone in 3 months. Outcome: A favorable neurological outcome was obtained 6 months later. Lessons: Neurological paradoxical reaction cannot be overlooked among the tuberculosis-treated cases who present with newly emerged neurological disorders.