A fatal case of miliary tuberculosis complicated by splenic rupture and reactive hemophagocytic syndrome is presented. A 42 yr old Indian patient with a 7 yr history of sarcoidosis developed miliary tuberculosis and hemophagocytic syndrome after steroid therapy. A ruptured enlarged spleen with hemoperitoneum was detected at autopsy. This case highlights the need to consider the occurrence of tuberculosis in patients with sarcoidosis, especially after steroid therapy. Yellow bodies (Hamazaki-Wesenberg bodies), commonly but not exclusively found in sarcoidosis, were identified within the retroperitoneal lymph nodes in this case.