A case of haemorrhagic fever with renal syndrome (HFRS) complicated by spleen haemorrhage is described. The patient developed progressive anaemia, hypotension and signs of preshock. Computerized tomography demonstrated extensive haematoma in the spleen and splenectomy was performed. This case confirms previous reports that HFRS caused by Puumala virus may be associated with severe haemorrhagic manifestations.