Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 4 2025 02 22 173 176 Matineh Sadat Tabatabaei Student Scientific Research Center (SSRC), Nursing and Midwifery School,Tehran University of Medical Sciences, Tehran, Iran. Saber Shafiei Student Scientific Research Center (SSRC), Nursing and Midwifery School,Tehran University of Medical Sciences, Tehran, Iran. Arash Chehreh Damavandi Motlagh Student Scientific Research Center (SSRC), Nursing and Midwifery School,Tehran University of Medical Sciences, Tehran, Iran. Mohammad Nasimi Trainee of Infectious Diseases Residency,Tehran University of Medical Sciences, Tehran, Iran. 2024 12 04 2025 01 06 Spinal tuberculosis (TB) is a rare extrapulmonary manifestation that can cause vertebral fractures, neurological deficits, and paraplegia. This report presents a 43-year-old male with sudden paraplegia, back pain, and sensory loss. MRI revealed fractures in T10, T11, and L5, and histopathology confirmed spinal TB with concurrent pulmonary TB and pleural effusion. The patient’s history of chronic dexamethasone misuse contributed to immunosuppression and disease dissemination. Classified as Grade 4 paraplegia, his condition required surgical stabilization, anti-TB therapy, and supportive care. This case highlights the rarity of multilevel vertebral fractures and severe neurological deficits in spinal TB, emphasizing the importance of early imaging, tissue biopsy, and prompt multidisciplinary intervention to prevent permanent disability. https://crcp.tums.ac.ir/index.php/crcp/article/view/1004 https://crcp.tums.ac.ir/index.php/crcp/article/download/1004/679