In patients undergoing maintenance hemodialysis, the incidence of tuberculosis is high and the clinical features of the disease are not characteristic because of increased extrapulmonary or miliary tuberculosis. We describe a dialysis patient with fever of unknown origin and ascites in whom tuberculous peritonitis was diagnosed by laparoscopy.The patient was a 55-year-old male who had no past history of tuberculosis. He had been treated because of chronic renal failure from the age of 50 years, and had received hemodialysis therapy since he was 52 years old. For 3 months before admission. He had anorexia, nausea and vomiting. On admission, a temperature of 38°C and ascites were noted. Chest X-ray films were normal and abdominal X-ray revealed increased gas in the small intestine but no abnormal calcification. Marked anemia was noted. Neutrophilia, increased erythrocyte sedimentation rate and a positive C-reactive protein reaction were found, but other laboratory tests were normal. Examination of the gastrointestinal tract was normal. Abdominal ultrasonvgraphy and abdominal CT scans revealed no abnormal findings exoept ascites.Aspirated ascitic fluid was light yellow-red and exudative with fibrin precipitation. Cultures for microorganisms were negative and cytology repealed Class II.Since carcinomatous or tuberculous peritonitis was suspected, a laparoscopy was performed. Multiple millet-seed sized light yellow nodules were seen on the intestinal serosa and the parietal peritoneum, and there was marked fibrous adhesion. Tuberculous granulomas with epithelioid cells and multinuclear giant cells were revealed histologically in biopsies of these nodules.We diagnosed the condition as tuberculous peritonitis.Anti-tuberculosis therapy improved his clinical symptoms. Four months later, at the second laporoscopy examination, the nodules previously seen had disappeared and healing of the disease was demonstrated laporoscopically at this time.In dialysis patients with fever of unknown origin and ascites, laparoscopic examination is a very useful procedure for diagnosis of extrapulmonary tuberculosis and confirmation of the effect of treatment.