On examination, the patient had normal vital signs and appeared well. His abdomen was distended with a fluid wave and he had mild right upper quadrant tenderness but no rebound, guarding, or masses. Chemistry, complete blood cell count, and liver function test findings were significant only for mild anemia. Results of an upper endoscopy were normal. Computed tomography of his abdomen and pelvis demonstrated studding of his peritoneal lining (Figure 1) and large ascites as well as a 2-cm nodule in his right lower lobe. Chest computed tomography demonstrated no further abnormalities and the lesion was biopsied under computed tomographic guidance with findings of “granulomatous disease.” A paracentesis aspirated 1.4 L of serous ascitic fluid that showed numerous lymphocytes but pathology and culture results were negative. The patient then underwent diagnostic laparoscopy with peritoneal biopsy with findings as shown in Figure 2.