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Background: One of the most serious types of meningitis caused by Mycobacterium tuberculosis (MTB) which involves meningeal layer and is usually associated with high mortality and morbidity. We focused on the significance diagnosis and prompt treatment. Methods: We describe a case of TBM.In a 40-Year-old Asian male. He was no respiratory distress, neck stiffness, constipation, and nausea, but frequent urination. In addition, the patient had a history of drug addiction. Results: His Magnetic Resonance Imaging (MRI) showed hyperintense Lesions. Sputum culture for Mycobacterium tuberculosis (MTB) was found positive and he was given a therapeutic trial of quinolones and Steroids. Conclusion: Observing the principles of biological safety among the personnel of medical centers and screening for TB disease in drug-positive and HIV-positive is essential.