A 21-year-old woman was admitted to our hospital for numbness in bilateral lower limbs and in the chest for 7 days. She had a past medical history of PTB without receiving any treatment for 3 years. On neurological examination, the muscle strength in the upper limbs and lower limbs were 5/5 according to the MRC grade. Hyperreflexia was found in bilateral lower limbs. She was found loss of sensation of pain and touch in the spinal segments below T4. Bilateral Babinski sign were positive. Four days after admission, the muscle strength in bilateral lower limbs were 4/5 according to the MRC grade, with retention of urine. The EDSS of the patient was 4.5 during hospitalization. The MRI scan during hospitalization of cervical and thoracic spinal cord revealed diffuse hyperintense signal extending C3 to T11 on T2W and FLAIR images and hypointense signal on T1W images (Fig. 5A-C). The MRI of the thoracic spinal cord revealed altered medullary signal intensity from C6 to T11 levels, appearing hyperintense on T1W and T2W images (Fig. 5B). The chest CT showed left upper lobe tuberculosis with cavitation (Fig. 5D). CSF routine test showed increased protein levels (0.48 g/L, normal range from 0.15 to 0.45 g/L). The CSF cell numbers were within the normal range (4 x 106/L). The anti-AQP4-Ab was negative both in the serum and in the CSF of the patient. Tuberculosis mycobacterium antibody was negative both in serum and CSF. A combination of corticosteroid and anti-tuberculosis treatment (isonicotinyl hydrazide 0.3 g/d, rifampin 0.45 g/d, pyrazinamide 1 g/d, ethambutol 1 g/d, and dexamethasone 15 mg/d) was given. Neurological dysfunction was ameliorated significantly. The lesion size in the spinal cord and in the lung were significantly reduced 1 month later after discharge from the hospital. The EDSS of the patient dropped to 0 at the follow up time when 3 months after discharge from the hospital.