A 25-year-old male, a worker in a garment factory, presented with complaints of band like feeling in the upper abdomen, not associated with any abdominal or back pain for 3 months duration. Simultaneously he had urinary hesitancy, a feeling of incomplete voiding of urine along with sense of inadequate evacuation of stool. Fifteen days later he developed descending paresthesia from the upper abdomen up to the both feet followed by weakness of trunk muscles, weakness and tightness of both lower limbs over a period of 2 months, which initially started in left lower limb and subsequently involved the right lower limb. There was no loss of perianal sensation. On examination, his higher mental functions and cranial nerves were normal. His upper limb power was 5 on both sides with normal tone and deep tendon reflexes. His lower limb power was 3 with hypertonia, exaggerated reflexes and ill-sustained clonus on the both side. He had sensory impairment below T5 corresponding to vertebral level D3. General physical examination and other system examinations were normal. A provisional diagnosis of thoracic myelopathy was made and patient was investigated. His complete blood count, renal profile, liver function tests, human immunodeficiency virus (HIV) and hepatitis B surface antigen were negative. His chest X-ray was normal. Erythrocyte sedimentation rate was moderately high and Mantoux was nonreactive. Magnetic resonance imaging (MRI) of whole cord revealed an iso- to hypointense lesion at D3 level on T1-weighted imaging (T1WI). The lesion was iso- to subtle hyperintense with central flow void onT2-weighted imaging (T2WI) [Figure 1], with cord edema rostral to the mass. Contrast-enhanced MRI showed a brilliantly enhancing lesion with hypointense centre at D3 with sharp margins [Figure 2]. The oval-shaped lesion measured 16 x 10 mm. The diagnosis was intramedullary spinal cord tumor by MRI. Because of worsening of the patient's neurological examination, surgical removal of the lesion was undertaken. At D3-4, laminectomy was performed, posterior longidutinal myelotomy was executed, and a well-circumscribed pinkish fleshy mass [Figure 3] was found to be located 2 mm anterior to posterior aspect of the cord. The lesion was dissected along a readily definable plane and was removed totally by use of the operating microscope. The histopathology showed multiple granulomas [Figure 4] comprising of lymphocytes plasma cells, neutrophils, and large number of epitheloid cells [Figure 5]in clusters with demonstration of acid fast bacilli (AFB) [Figure 6] typical of Mycobacterium tuberculosis. Postoperatively the patient was given antituberculus treatment (ATT), started with isoniazid (INH) 300 mg/day, rifampicin (RF) 450 mg/day, pyrazinamide 1500 mg/day, and ethambutol 800 mg/day daily for 2 months, followed by INH and RF for 10 months. Pyridoxine at 40 mg/day was given for all 10 months. Postoperatively, the patient's neurological examination gradually improved and he could sit erect on the bed and able to walk over a period of 3 weeks without support. The follow-up time is 1 1/2 year.