Disseminated Mycobacterium avium complex (MAC) infections occur in late stage of AIDS. Highly active antiretroviral therapy (HAART) decreases the incidence of MAC infection, but patients with low CD4 counts who have no access to HAART, are remained at risk. The intestine is involved in disseminated MAC which causes gastrointestinal tract symptoms. Spontaneous perforation of small bowel, only ileum by disseminated MAC is documented in one case report. We present a rare case of disseminated MAC infection that led to the multiple spontaneous perforation of small intestine in ileum and cecum. The patient deceased, despite immediate surgical intervention. Mycobacterium avium complex is an important cause of multiple, spontaneous small bowel perforation. We recommend administrating MAC prophylaxis in HIV positive patients who do not have access to HAART therapy.