We report on a rare case of splenic abscess due to spontaneous Escherichia coli bacteremia in a 49-year old cirrhotic. No other source potentially responsible for bacteremia was found through careful diagnostic research. Splenic abscess appeared from ultrasonography and computerized tomography as a 6-7 cm lesion located at the lower splenic pole. Blood cultures allowed to isolate E. coli which, on the basis of antibiotic susceptibility, was treated by a 21-day intravenous cetazidime course at a dose of 6 g/day. The isolated E. coli strain resulted as quinolone-resistant. Disappearance either of high fever or of abscessual splenic lesion was achieved without surgery after the antibiotic round. Spontaneous bacteremia may occur in cirrhotic patients due to intestinal bacteria traslocation from gut lumen to blood. Nevertheless, isolated splenic localization is a very rare event.