1 IntroductionSpinal tuberculosis is a rare condition. The presentation of central nervous system tuberculosis with spinal cord symptoms as the initial manifestation constitutes approximately 0.02‰ of systemic tuberculosis cases and 2‰ of central nervous system tuberculosis cases. This disease typically has an insidious onset and lacks distinct clinical manifestations, which can lead to missed or misdiagnosed cases. However, it is associated with high rates of disability and mortality. Most of the existing literature on tuberculous myelitis is derived from case reports. The pathogenesis of tuberculous myelitis is primarily attributed to the dissemination of Mycobacterium tuberculosis from other areas of the body, predominantly the lungs, via the bloodstream, direct infiltration from spinal tuberculosis, or through the pathogenic bacteria and inflammatory exudates associated with tuberculous meningitis. The bacteria spread through the cerebrospinal fluid, leading to damage of the spinal cord. Tuberculous myelitis that originates specifically in spinal cord segments is considerably rarer. The clinical manifestations of this condition vary based on the site of involvement. Most patients ultimately experience paralysis, sensory deficits, and urinary and fecal dysfunction below the level of the spinal cord lesions. In this case, the patient initially presented with low back pain, which was followed by a gradual onset of weakness in both lower limbs and urinary retention. The condition progressed rapidly. At the time of admission, no signs of tuberculosis in other regions of the body were identified, suggesting a greater likelihood of spinal cord origin.Summary： Mycobacterium tuberculosis is a very rare cause of transverse myelitis, especially tuberculous myelitis without meningitis, which is even rarer. Doctors can identify spinal cord tuberculosis early through medical history, physical examination, cerebrospinal fluid examination results, and spinal cord MRI results, and treat it early, so that patients can have a better prognosis.