Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. We report a case in HIV infected patient with evidence of symptoms of systemic tuberculosis who presented with a history of progressive leg weakness, urinary urgency, and impotence. Thoracic MRI showed disseminated micronodular lesions. Abdominal MRI revealed ascitis, necrosed retroperitoneal adenopathies. Ascitis liquid acid-fast bacilli stainings and cultures were positive. MRI of the brain revealed multiple infracentimetric nodular lesions in the cerebral parenchyma and in cerebellar vermis. MRI of spinal cord revealed two intramedullary hyper intense lesions measuring 10 mm and 7 mm interesting the terminal cones. Gd-DTPA-enhanced MRI showed enhancement of the two intramedullary lesions. The lesion, was located in the cones medullaris. Antituberculous medication was instituted as soon as the diagnosis was made. Neurologic symptoms and signs slowly improved.