A 17-year-old Indian man presented with a 1-month history of low-grade fever with anorexia followed by a 5-day history of acute sensorimotor paraparesis. There was no preceding or concurrent history of any gastroenteritis or other illness. There was no past history of any previous similar illness. The patient was well-built and nourished. Both legs had three-fifth power, absent of tendon reflexes and anesthesia below D9 spinal level. There was no palpable lymphadenopathy. Spinal magnetic resonance imaging (MRI) revealed a multi-segment confluent patchy nonmass-like granulomatous central intramedullary T1-weighted isointense and T2-weighted hyperintense signal abnormality from D7 to conus medullaris without cord expansion suggestive of granulomatous myelitis [Figure 1]. There was a marked postgadolinium enhancement on cord surface, extramedullary epidural and subdural abscesses along the cervical and dorsal cord, abnormal clumping, and contrast enhancement of cauda equina roots [Figure 2]. Vertebrae, intervertebral discs, and brain MRI were normal. Cerebrospinal fluid (CSF) analysis showed a normal opening pressure, with 230 cells/cumm (98% lymphocytes), 236 mg/dL proteins, and glucose 27 mg/dL (matching serum glucose 92 mg/dL). Antinuclear antibody and antiaquaporin-4 antibodies (AQP4-IgG) (by indirect immunofluorescence using transfected HEK2 cells and primate optic nerve as substrate) were negative, and acetylcholine esterase level was normal. Mycobacterium TB-polymerase chain reaction (PCR) in CSF was positive. HIV-ELISA was negative. The patient was neither immunosuppressed due to any illness nor was there any history of iatrogenic immunosuppression by any drugs. His chest X-ray (CXR) was normal [Figure 3], and sputum was negative for acid-fast Bacilli. Chest and abdomen computed tomography (CT) showed three soft tissue nodules in the right upper lobe, one in the right lower lobe and multiple peribronchial nodules, some with central cavitation and a 3 cm x 3.5 cm necrotic subcarinal lymph node [Figure 4]. CT was thus suggestive of endobronchial TB with tuberculous lymphadenitis. The patient did not consent for a bronchoscopic lymph node biopsy. Thus, a final diagnosis of tuberculous longitudinally extensive myeloradiculopathy was made. The patient was given dexamethasone in tapering dose with 4-drug antitubercular therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months, followed by isoniazid and rifampicin for 10 more months. Our patient was ambulatory without support within 2 weeks of treatment initiation and attained full power by the 5th week. He continues to be under our follow-up since last 18 months with no residual deficits. The patient refused for a repeat MRI scan due to severe claustrophobia in the first imaging and as he had improved.