Background : Splenic involvement and multiple abscess formation in tuberculosis disease (TB) are rare. The fact that the most common cause of splenic abscess formation is infection, this complication should always be in the differential diagnosis, especially in patients with febrile diseases and immune deficiency and or intravenous drug abuser. Tuberculosis splenic abscess may be the first and only sign of tuberculosis.

  Case Report: A 30- year old addicted and HIV positive man admitted to Bu-Ali hospital of Tehran with symptoms of fever, chills, fatigue, weight loss since 2 months ago, characteristic sepsis, jaundice and very bad general condition. Ultra-sonography and CT scan showed some masses (abscess) in the liver, spleen, pancreas and some Para-aortic lymph nodes. Patient underwent laparotomy because of abdominal pain, tenderness and rebound tenderness. Abundant small abscesses were seen in the spleen during operation and then splenectomy was done. The patient passed away next day after operation. Pathologic study revealed multiple abscesses in the spleen containing numerous positive acid-fast bacilli.