eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2015-09-18 3 10 344 346 10.12691/ajmcr-3-10-10 AJMCR201531010 article Heda Melinda heda_1155@yahoo.com 1 Minerva Kadir 1 Department of Child Health Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia Clinical deterioration during treated with anti-tuberculosis drug (ATD) is not common occured in immunocompetent children, remains a great dilemma. It requires medical attention, practitioners should be considered as multi-drug resistant tuberculosis (MDR-TB) or paradoxical response. We report a challenging case of a-12-year-old girl presented with clinical deterioration severe respiratory distress transferred to isolated pediatric intensive care unit while on TB treatment. On admission, chest X-ray revealed pneumothorax in left lung and bilateral pulmonary infiltration. During evalution, she had seizure and decreased consciousness, and later diagnosed as as tuberculous meningitis (TBM). She had close contact with her acid-fast bacillus (AFB)-positive, Gene Xpert MTB/RIF negative-mother. Five other siblings were diagnosed as having TB as well. The patient was first suspected as having MDR-TB, while Gene Xpert MTB/RIF test revealed still positive. The patient then showed good clinical improvement after TB treatment. http://pubs.sciepub.com/ajmcr/3/10/10/ajmcr-3-10-10.pdf tuberculosis MDR-TB paradoxical response Gene Xpert MTB/RIF