Tuberculous peritonitis is a slow developed disease with non-specific symptoms. When a latent tuber-culosis lesion is reactivated, its mortality rate is high. In this case, a 60-year-old man was presented with abdominal distension and tenderness. Intermittent fever and intra-abdominal ascites were also noted. After using empiric antibiotics with Imipenem 500 mg + Cilastatin sodium 500 mg to treat spontaneous peritonitis, his fever gradually subsided, but the abdominal distension and tenderness persisted. Due to recurrent ascites and fever, the possibility of tuberculosis infection and malignancy were highly suspected. Abdominal computerized tomography examination was arranged and revealed multiple nodules and infiltrations at the peritoneum. Laparoscopy surgical biopsy of peritoneal tissues were performed and the pathological reports confirmed the diagnosis of tuberculous peritonitis. The patient was treated with anti-tuberculosis drugs, but eventually expired due to acute liver failure four days after anti-tuberculosis drugs prescription. When a patient is presented with abdominal distension and tenderness accompanied with ascites and intermittent fever, antibiotics treatment is ineffective in corresponded to laboratory test data. Tuberculosis infection needs to be considered as one of the differential diagnosis. Detailed physical assessment, follow-up test values tracking and surgical biopsy can help establish an early diagnosis.