Peritonitis is an unusual extrapulmonary manifestation of coccidioidomycosis. Peritoneal involvement often has an indolent course and may resolve spontaneously. Optimal management has not been defined; however, fluconazole's spectrum of activity, pharmacokinetic profile, and efficacy in dialysis-related yeast peritonitis suggest that it may be an effective treatment. To our knowledge, we report the first case of coccidioidal peritonitis treated with fluconazole and review the literature.