We present a case of tuberculous peritonitis in the setting of alcoholic cirrhosis with ascites. A young American Indian male with alcoholic cirrhosis and ascites presented with low grade fever and weight loss. A diagnosis of tuberculous peritonitis was made by laparoscopic guided peritoneal biopsy. He was treated successfully with isoniazid and ethambutol for 24 months. The diagnosis of tuberculous peritonitis should be entertained in high risk populations such as American Indians, Asians, alcoholics, chronic ambulatory peritoneal dialysis patients and AIDS patients in the appropriate clinical setting. Definitive diagnosis can usually be made by laparoscopic guided peritoneal biopsy.

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