A 78-year-old woman was diagnosed with advanced gastric cancer with multiple lymph node metastases in January 2017. She received second-line chemotherapy with ramucirumab plus paclitaxel starting in August 2017 after failure of first-line chemotherapy. Because of complications with gastrointestinal hemorrhage due to primary gastric tumor, weekly paclitaxel monotherapy was continued from October 2017, which achieved stable disease. Four months after the beginning of second-line chemotherapy and 1 week before hospitalization, she was febrile with a temperature of 38.0 C and consulted the outpatient department. She presented with no accompanying symptoms other than fever and showed no abnormalities in physical examinations. Moreover, her complete blood count tests, serum chemistry, urinalysis, and blood culture revealed no significant findings; therefore, she was discharged home with oral antipyretics. However, 4 days later, she was febrile again with a temperature of 39.8 C along with drowsiness and was admitted to our hospital. After admission, she almost returned to full consciousness without headache and meningeal irritation signs. A computed tomography (CT) scan did not identify a significant abnormality in the brain but revealed an emerging small infiltration in the right upper lung lobe as a possible cause of the fever. She was empirically treated with piperacillin/tazobactam for possible bacterial pneumonia. Her fever gradually improved up to the 7th day of hospitalization; however, thereafter, her mild disturbance of consciousness in the form of delirium was worsening and a fever of 38-39 C was once again observed around the 10th day of hospitalization. Her disturbance of consciousness finally progressed to drowsiness by the 14th day of hospitalization. A brain CT scan on the 14th day revealed apparent ventricular enlargement and periventricular edematous changes compared with that on admission (Fig. 1). Cerebrospinal fluid was collected through a lumbar puncture, which showed a significant increase in the number of mononuclear cells (Table 1). Due to her accompanying advanced gastric cancer, meningitis carcinomatosis was first suspected, for which dexamethasone (6.6 mg/day) treatment was initiated while waiting for cytology results. However, her disturbance of consciousness persisted and deteriorated further, and another cerebrospinal fluid test was performed on the 19th day of hospitalization because of negative cytology results in the first investigation. A significant increase in polynuclear cell numbers and overall cell counts as well as a decrease in the glucose content of the cerebrospinal fluid was noted (Table 1). The cerebrospinal fluid samples were submitted for bacterial, mycobacterial, and fungal cultures. An acid-fast bacilli test of the cerebrospinal fluid was negative, but we initiated empirical anti-tuberculosis treatment since tuberculous meningitis could not be excluded with subacute onset of symptoms. On the 22nd day of hospitalization, positive tuberculosis-polymerase chain reaction (TB-PCR) of the cerebrospinal fluid confirmed the diagnosis of tuberculous meningitis. Her sputum tested was also positive on TB-PCR. Because oral medication was not possible, a triple-drug combination therapy consisting of isoniazid, levofloxacin, and streptomycin was initiated. She continued to receive anti-tuberculosis treatment, and her state of consciousness temporarily improved. Unfortunately, she died on the 37th day of hospitalization due to gastrointestinal bleeding from the gastric cancer.