Objective: Occurrence of Immune reconstitution inflammatory syndrome (IRIS)/Paradoxical reaction (PR) in patients of tuberculosis is a source of diagnostic dilemma to the clinician and is sometimes confused with drug resistance. The objectives of this research were to observe the prevalence and study the natural fate of IRIS/PR in patients of HIV negative EPTB. Material and Methods: A single centre prospective observational study was conducted at King George‘s Medical University, Lucknow, India over a period of 18 months (June2016–December 2017) and HIV negative patients of EPTB who were on anti–tubercular treatment(ATT) were followed and observed for various PR which resulted due to immune reconstitution phenomenon. Results: 324 subjects of EPTB who were on Anti tubercular therapy (ATT) were recruited for the study. Out of these, 56 (17.3%) patients reported with paradoxical reactions. Most commonly encountered paradoxical reaction was appearance of new lymph nodes which was observed in 34 patients (60.7%) followed by enlargement of existing lymph nodes/cold abscess which was seen in 15 (26.7%) patients, paradoxical reaction in the form of pleural effusion was observed in 7 patients (12.5%), involvement of pericardium was observed in 1 patient (1.78%). Most of the IRIS manifestations occurred during the first quarter of ATT (95%). Conclusion: IRIS was uncommonly seen (17.3%) in patients of extra pulmonary tuberculosis. It was observed that the IRIS manifestations resolved during the course of treatment in 42 (75%) without any intervention except that the treatment was prolonged, 14 patients (25%) however required some form of treatment.