Tuberculosis of the central nervous system has a large proportion among all extrapulmonary tuberculous lesions forms and is an urgent and socially significant problem, despite the development and availability of modern diagnostic methods (radiation diagnostics, cerebrospinal fluid PCR) and treatment. A high disability and mortality level in tuberculous meningoencephalomyelitis is often caused by an untimely clinical diagnosis, which may be associated with an atypical clinical picture of the disease, as well as insufficient information content of the results of instrumental and immunological examination. The authors present a case of tuberculous meningoencephalomyelitis in a female patient without concomitant HIV infection, in the absence of manifestations of visceral, including pulmonary, tuberculosis throughout the disease. Despite the fact that the tuberculous nature of the nervous system lesion was suspected at the initial neurological examination stage, the diagnosis was complicated by the lack of laboratory confirmation by a positive PCR test for Mycobacterium tuberculosis during repeated cerebrospinal fluid studies. Nevertheless, due to the dramatic development of the situation (progressive deterioration of the patient’s condition, confusion of consciousness deepening to the coma level) and the direct threat to the life of the patient, it was decided to prescribe anti-tuberculosis therapy «ex juvantibus», which led to a rapid neurological symptoms regression and, ultimately, almost complete neurological deficits recovery. The case is atypical because tuberculous damage to the nervous system (in the form of a positive PCR test for Mycobacterium tuberculosis) was confirmed only on the third day of anti-tuberculosis therapy, and microbiological confirmation of tuberculosis invasion was established only on the 12th day from the start of specific therapy (the 23rd day of illness).