<p>A 32-year-old woman with H/o DM with complaints of abdominal distention and increased abdominal girth associated with shortness of breath visited the clinic. The patient had normal vitals. On examination, the abdomen was soft and distended with positive shifting dullness. Bowel sounds were normal. CT scan of the abdomen and pelvis with contrast showed many ascites with standard hepatic architecture. Ultrasound of the pelvis showed large-volume ascites and normal-appearing ovaries and uterus. Of note, she was found to have an ADA level of 113 in ascitic fluid, Ascitic fluid amylase level was 46 U/L, TAG level was 22 mg/dL, and LDH level was 554 U/L. Acid-fast staining, MTB PCR, and mycobacterium cultures were negative in ascitic fluid.&nbsp;</p>

<p>She underwent exploratory abdominal laparoscopy, which revealed fibrinous exudate on the peritoneal surface. She had a biopsy of the peritoneum following it. The pathology report from the peritoneal biopsy showed granulomatous inflammation with no malignancy, as shown in the figure. A diagnosis of TB peritonitis was made</p>