IntroductionTuberculosis (TB) is one of the most common global health burdens caused by Mycobacterium Tuberculosis.1 Almost half of the TB cases remain unreported, contributing to the underdiagnosis of extrapulmonary tuberculosis.2 The worldwide incidence of disseminated TB is also in increasing trend. Central nervous system (CNS) involvement is one of the most devastating complications of tuberculosis and is seen in 10% of all disseminated TB cases, accounting for 1% of all TB cases.3 CNS involvement may present as meningitis, cerebral tuberculoma, tuberculoma abscess, and thoracic transverse myelopathy.1,4The predominant symptoms of disseminated TB are fever, cough, malaise, loss of appetite, weakness, and weight loss. In addition, symptoms according to system involvement are often seen, like a headache in the case of meningeal tuberculosis and abdominal pain in peritoneal or intestinal tuberculosis.5Although the treatment of disseminated and pulmonary TB are considered the same, CNS involvement warrants a longer duration of treatment. The four-drug regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol is administered daily for two months, followed by rifampicin and isoniazid for two months. In disseminated cases, these two drug regimens can be extended. There is no clear evidence of the effectiveness of corticosteroids in disseminated TB cases. However, steroids are often used in disseminated cases. 6 Early identification and prompt management are the cornerstones for optimal patient management in disseminated TB with CNS involvement.We reported this case following the updated consensus-based Surgical Case Report (SCARE) Guidelines. 7