Seven patients had granulomatous peritonitis due to Coccidioides immitis. Symptoms varied from painless abdominal distension to generalized abdominal tenderness with signs of peritoneal irritation, fever, anorexia, and vomiting. The diagnoses were made incidentally during the following operations: herniorrhaphy (one), abdominal paracentesis (one), laparoscopy and biopsy (one), and exploratory laparotomy (four). Spherules of C immitis were identified in histologic sections of biopsies and also in peritoneal fluid. Two of the seven patients died of generalized dissemination; the other five patients are well. Coccidioidal peritonitis is a rare complication of pulmonary coccidioidomycosis and is best treated nonsurgically, symptomatically, or with amphotericin B (Fungizone).