Adalimumab treatment may replace or enhance the activity of steroids in steroid-refractory tuberculous meningitis.

We describe a paradoxical response involving the central nervous system in a patient with steroid-refractory tuberculous meningitis that was unresponsive to systemic corticosteroids but was improved with adalimumab. The immunomodulatory effect of tumor necrosis factor inhibitors may have a role in replacing or enhancing the activity of steroids in the management of steroid-refractory tuberculous meningitis.