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Longitudinally extensive transverse myelitis (LETM) is a rare but severe manifestation of central nervous system (CNS) tuberculosis (TB). Because of its nonspecific clinical presentation and broad differential diagnosis, early recognition remains challenging. We report the case of a 27-year-old man with concurrent pulmonary and meningeal TB who developed rapidly progressive quadriparesis. Magnetic resonance imaging demonstrated longitudinally extensive T2-hyperintense lesions extending from C2 to T12, accompanied by diffuse meningeal enhancement, consistent with TB LETM. The patient was treated with anti-TB therapy, high-dose corticosteroids, intravenous immunoglobulin, and plasmapheresis. Despite aggressive treatment, his neurological status progressively deteriorated, ultimately resulting in death. We also conducted a comprehensive literature review to identify all previously reported cases of TB-associated LETM and summarized their clinical characteristics, extent of spinal cord involvement, treatment approaches, and outcomes. Although TB remains a major global health challenge, spinal cord involvement presenting as LETM is exceptionally rare. Prompt recognition and early initiation of appropriate therapy are essential; however, neurological outcomes may remain poor despite aggressive treatment.