Spontaneous bladder rupture (SBR) is an uncommon disease and is associated with significant morbidity and mortality. Urinary tract tuberculosis complicated with SBR has rarely been reported. How to identify this unusual etiology and initiate appropriate treatment is a clinical challenge. Herein, we present a patient with SBR due to urinary tract tuberculosis and concurrent Escherichia coli bacteriuria. Conservative treatment with bladder catheterization accompanied by anti-tuberculosis therapy was successful to offer complete healing of bladder rupture and tuberculosis. Clinicians must be aware of urinary tract tuberculosis being a possible underlying cause of SBR even in the presence of bacteriuria. (Acta Nephrologica 2011; 25: 144-147)