A 21-year-old male showing right pleural effusion underwent thoracentesis in April 2011. He was diagnosed as having tuberculous pleurisy after a positive QFT-TB test, in addition to the characteristics of the exudate fluid demonstrating an increase in both lymphocytes and adenosine deaminase (ADA). He commenced antituberculous therapy (HREZ) in June 2011, after which he developed right anterior chest pain. Thoracic CT demonstrated the consolidation in the right middle lobe. We performed a bronchofiberscopy for diagnosis of the intrapulmonary lesion. Although we obtained epithelioid cell granuloma by transbronchial lung biopsy, both culture using lung tissue and PCR for Mycobacterium tuberculosis using bronchial washing were negative. We diagnosed as the paradoxical response and continued with therapy. After continuation of the treatment for three months, intrapulmonary lesion and pleural effusion were both improved.