ABSTRACT
Introduction: Disseminated tuberculosis is a form ofwidespread bacilli infection with typical involvement ofthe lungs and other extra pulmonary organs. It is a raremanifestation of mycobacterial infection and rare amongimmune competent individuals.Case report: We present a case of disseminated extrapulmonary tuberculosis co-occurring tuberculous meningitis,CNS tuberculomas and Liver tuberculomas. Our patientdeveloped atypical respiratory complications in the form ofARDS like features which also called as Landouzy Sepsis,despite apparent normal Chest x-ray following initiation ofAnti Tubercular Therapy. Also patient developed paradoxicalreactions to tuberculous meningitis during the treatment.Conclusion: Awareness about paradoxical reactions intuberculous meningitis is very much crucial as paradoxicalreactions may lead to confusion about diagnostic accuracy andresistance of ATT drugs. Paradoxical reactions do not affectthe outcome but require prompt treatment to the complicationslike hydrocephalus and respiratory distress.