An 80-year-old male was treated with standard antituberculosis agents for lung tuberculosis of the right upper lobe. After discontinuation of this treatment, his chest radiograph showed new infiltration in the right lower lobe of lung. Bronchial lavage of the right basal bronchus revealed polymerase chain reaction positivity, but culture negativity for Mycobacterium tuberculosis complex and a biopsy specimen showed intra-alveolar organization and fibrosis. Furthermore, bronchoscopic findings of the right B¹ were compatible with bronchial tuberculosis. These results suggest that dead bacteria in the right B¹ were transbronchially spread to the ipsilateral lower lobe, raising an allergic reaction and forming an organized lesion. Locally hypersensitive response to the dead bacteria may be the main pathogenesis of the “paradoxical response.” Moreover, it is important to consider bronchial tuberculosis when a new lesion in an area away from the original disease is observed in pulmonary tuberculosis showing no cavitary lesion.