Intramedullary spinal tuberculoma is a rare form of extrapulmonary tuberculosis. In most cases the diagnosis is made by biopsy of the lesion and histopathological study. We present the case of a 28-year-old male with a history of malnutrition and drug use who presented progressive paraparesis with sphincter compromise secondary to a dorsal intramedullary tuberculoma. At the beginning a tumor lesion was suspected, however, findings of pulmonary tuberculosis, lymph node biopsy and a positive tuberculin protein derivative study confirmed the clinical diagnosis of spinal tuberculoma.