Case report: A 42-year-old Chinese man presented with the complaints of weakness of the lower extremities and urinary retention. Neurological examinations confirmed the motor dysfunction of the lower extremities and hypesthesia in areas below the T8 dermatome. Results from laboratory studies were normal and X-ray over the chest and thoracolumbar spine showed no signs of tuberculosis. However, the magnetic resonance imaging (MRI) scan detected a ring-enhancing intramedullary lesion at the T6-7 intervertebral level. The condition was diagnosed as intramedullary glioma. A neurosurgical resection was carried out, and the pathological examination following the surgery confirmed the tubercular lesion. The patient was treated with antituberculous therapy after the surgery and resulted in a satisfactory recovery. Conclusion: Intramedullary spinal tuberculoma (IMT) is rare, and the diagnosis for IMT is often difficult and inconclusive, especially in patients without symptoms of systemic tuberculosis. Although the management of IMT remains challenging, our report suggests that the combination of microsurgical resection and antituberculous chemotherapy may represent an effective treatment strategy for IMT.