摘要Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category Ⅰ anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.