Rationale: Tuberculous meningitis is a highly morbid, often fatal disease.
Patient concern: We describe a case of an Italian child.
Diagnoses: we diagnosed early a Tuberculous meningitis complicated by the occurrence of hydrocephalus, stroke, and
paradoxical reaction with brain pseudo-abscesses.
Interventions: The child started readily a specific therapy associated with steroids and thalidomide was introduced few month later.
Outcomes: the patient had a favorable outcome without neurologic sequelae.
Lessons: Despite the prompt specific anti-tubercular and adjuvant corticosteroid therapies, only the addition of thalidomide to the
treatment allow to a favorable clinical outcome
