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Eosinophilic ascites is an uncommon clinical entity with diagnostic considerations separate from those of spontaneous bacterial peritonitis (SBP). We decribe a man with documented E. coli SBP with an 80% eosinophilia in peritoneal fluid (total cell count 12,400/mm3) and no peripheral eosinophilia. Antimicrobial therapy resulted in both clinical improvement and resolution of the eosinophilia in the ascitic fluid. The possible role of associated medications and the potential importance of this syndrome are discussed.