INTRODUCTION: Because a substantial number of patients present with few or atypical symptoms, the recognition of tuberculosis remains challenging. Disseminated tuberculosis presenting with septic shock has already been described in some case reports, but, to the best of our knowledge, it has never been associated with polymorphonuclear effusion. CASE PRESENTATION: We describe the case of a 27-year-old man from western Africa who was seropositive for human immunodeficiency virus. He presented with pleural and abdominal polymorphonuclear effusions and quickly developed septic shock due to disseminated Mycobacterium tuberculosis infection leading to multiple organ failure and death. CONCLUSION: In high-risk patients, Mycobacterium tuberculosis infection should be considered even in exceptional clinical presentations, such as septic shock and polymorphonuclear effusions.