A 45-year-old HIV-negative man was treated with intravenous etimicin sulphate for an unintentionally found, non-tender neck mass at a local outpatient clinic. His symptoms seemed improved initially. However, the unilateral mass subsequently became enlarged quickly and painful. Spontaneous discharge occurred after admission to our department. The smear of the pus from surgical drainage was positive for acid-fast bacilli and the presence of Mycobacterium tuberculosis was confirmed by culture. He was diagnosed with an acute paradoxical reaction (PR) of cervical tuberculous lymphadenitis. Our case was unusual in that acute PR of tuberculosis was caused by receiving single aminoglycoside agent which has not been proven to have therapeutic effect on TB infection and it is also the first case of PR induced by etimicin. The patient recovered well from a 6-month antituberculosis chemotherapy.