Tuberculomas of the central nervous system are common. However, the incidence of intraspinal intramedullary tuberculomas is very low, and a combination of intramedullary, intracranial, and pulmonary tuberculomas is extremely rare. We report a case of tuberculoma involving the brain and spine with pulmonary tuberculosis in a 46-year-old man initially presenting with back pain and weakness of both lower extremities. Conservative treatment with antituberculous medications resulted in complete resolution of his symptoms.