BACKGROUND: Miliary tuberculosis represents a difficult diagnosis in clinical practice. It is due to lymphohematogenous dissemination of M. tuberculosis usually presented in an immunocompromised host. Its association with autoimmune thrombocytopenia is rare. CLINICAL CASE: A 31-year-old male immunocompetent patient with miliary tuberculosis and immune thrombocytopenic purpura with good response to antituberculous treatment plus high dose of steroids. CONCLUSIONS: Although the diagnosis of immune thrombocytopenic purpura is eminently clinical, in cases of association with tuberculosis, bone marrow aspirate should be performed to do the differential diagnosis with tuberculous myelopthysis, hemophagocytic syndromes or hematological malignancies.