A 62-year-old man had been treated with INH, RFP, EB, and PZA for pulmonary tuberculosis. Six months after completing the treatment, he was admitted because of low grade fever and abdominal distension. His abdominal radiograph and CT showed ascites, which showed elevated ADA. He was diagnosed as tuberculous peritonitis, and treated with INH, RFP, and EB. Three days after starting treatment, the ascites abruptly disappeared, followed by bilateral pleural effusion and pulmonary edema. He was found to develop ARDS. His pleural fluid was removed and treated with steroid pulse therapy. In spite of improvement of dyspnea, general status gradually deteriorated and he died following two months and a half treatment. Ascites causing a marked increase in abdominal pressure in a patient with tuberculosis peritonitis might move into the thoracic cavity with an unknown mechanism, and the removal of ascites might be needed to prevent this phenomenon.