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We present the case of a 26-year-old Indian male who developed pleural effusion while undergoing treatment for tuberculous lymphadenitis. We describe the work-up for his condition and how he was managed. The possibility of development of a paradoxical reaction in the form of pleural effusion after initiation of anti-tuberculous therapy has to be kept in mind while treating such patients.

A 22-year-old male patient presented with a fever for the previous 10 days, breathlessness with dry cough for the previous 3 days and decreased urine output since the morning of admission. His history was unremarkable. He denied any history of joint pain, rashes, eye symptoms, haemoptysis or sinus disease and there was no history of illicit drug abuse. He was a nonsmoker with no history of alcohol intake and was not on any regular medications. Clinical examination revealed icterus, blood pressure of 130/85 mmHg, tachycardia (130 beats?min-1), tachypnoea (30 breaths?min-1) and a temperature of 39uC. His upper airways were normal on examination and there were reduced breath sounds and crackles at the