Objective: Spindle cell pseudotumors are rare manifestations of mycobacterial infections. We describe a case in the liver in an immunocompromised patient with tuberculosis. Method: A 28-year-old man, with active substance dependency, HIV-1 infection known for 7 years and acquired immunodeficiency syndrome for 3 years, was receiving tuberculostatic medication for disseminated tuberculosis and investigated for persistent fever. A liver ultrasonography confirmed a moderate hepatomegaly and showed multiple dispersed nodules in both lobes, with 1 to 3 cm of greater diameter. Results: A needle biopsy from one of the nodules showed a proliferation of spindle cells without atypia, grouped in intersecting bundles, with immunoreactivity to vimentin, CD68 and lysozyme and negative for CD34, pS100, SMA and desmin; a Ziehl-Neelsen stain revealed several acid fast bacilli in the spindle cells. They were PAS negative. Conclusion: Pseudotumoral lesions in hepatic tuberculosis usually correspond to granulomatous inflammation. A spindle cell proliferation, like that seen in other organs are more frequently associated with non tuberculous mycobacteria, is very rare. We found only another case in the literature of liver spindle cell pseudotumor associated with tuberculosis. This lesion must be differentiated from mesenchymal neoplasms.