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• Adenosine deaminase (ADA) in the cerebrospinal fluid (CSF) is not specific for diagnosing tuberculous meningitis in HIV infected patients. • Retroviral rebound syndrome can cause meningitis and can also cause ADA elevation in the CSF. • We have to be aware of retroviral rebound syndrome as a cause of ADA elevation in CSF, to avoid unnecessary anti-tuberculous treatment. Adenosine deaminase (ADA) in cerebrospinal fluid (CSF) is considered to be a useful biomarker in differentiating tuberculous meningitis (TBM) from other meningitis in non-HIV patients. However, its specificity decreases in patients with HIV, and other diseases such as cytomegalovirus encephalitis, toxoplasmosis or meningeal lymphomatosis can also elevate ADA in CSF. We here report a rare case of retroviral rebound syndrome in a HIV patient, whose ADA in CSF was elevated. [ABSTRACT FROM AUTHOR]