Background: The tuberculosis is an endemic disease in our country; it remains a major public health problem. Liver and splenic tuberculosis is a classic disease which represents 1.5% of all gastrointestinal tuberculosis. Patients and Methods: We reported the case of a fifty-six years old patient admitted in the department of surgery for acute cholecystitis, and the biological balance showed a hyperleukocytosis at 16,000 elements/mm³ and a CRP at 25 with a light cholestasis. The abdominal scanner showed a micronodular splenomegaly with coelio mesenteric ganglions. We discovered a tuberculosis location in the liver and the spleen and we realized a cholecystectomy with a hepatic biopsy and a splenectomy. Results: A gallbladder ablation associated with an enlarged spleen and liver biopsy was diagnosed with liver and splenic tuberculosis. The patient was put under anti tubercular treatment with the good clinical and radiological evolution. Conclusion: The diagnosis of tuberculosis should always be considered especially in endemic countries.