Abstract The fourth recorded survivor of a ruptured splenic aneurysm is presented. He is also remarkable for his multiple pathology including bacterial endocarditis, aortic incompetence with multiple peripheral embolism, and neurofibromatosis. It is emphasized that mycotic aneurysms of the spleen are an unusual complication of bacterial endocarditis, and a high index of suspicion is essential for their diagnosis. Treatment must be prompt and effective.