| Summary: | Key Clinical Message The low sensitivity of ascites culture for acid‐fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on computed tomography may prompt suspicion of tuberculous peritonitis. Abstract A 47‐year‐old Nigerian man presented with fever, abdominal distention, and weight loss. Abdominal computed tomography revealed massive ascites and peritoneal thickening. Despite failing to culture acid‐fast bacilli from ascites, histological examination and culture of peritoneum revealed multidrug‐resistant tuberculosis peritonitis. Peritoneal biopsy is mandatory when tuberculosis peritonitis is suspected.
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