INTRODUCTION: Spontaneous fungal peritonitis is an infection which occurs in patients with liver cirrhosis.Spontaneous fungal peritonitis is uncommon in a patient with cardiac ascites because of high protein content and low risk of infections.We present the second known case of SFP in a patient with cardiogenic ascites. CASE DESCRIPTION/METHODS: 52-year-old female with past medical history of COPD was admitted to the hospital with a two-week history of abdominal pain and dyspnea.Labratory findings showed WBC count of 7,900/mm3, ANC of 6936/mm3, hemoglobin 15.8, platelet count 406 × 103/mm3, creatinine 0.9mg/dL, total bilirubin 3.40 mg/dL, direct bilirubin 2.30 mg/dL, ammonia of 51. Initial imaging of CT abdomen and pelvis showed bilateral pleural effusions, moderate ascites, and liver cirrhosis. ECHO showed left ventricular ejection fraction of 55%, dilated right ventricle, moderate tricuspid regurgitation with right ventricular systolic pressure of 76 mm Hg. Diagnostic and therapeutic ultrasound guided paracentesis was done and 400 mL of fluid was removed and sent for analysis and culture. Patient was empirically started on ceftriaxone for possible spontaneous bacterial peritonitis. Ascitic fluid analysis showed hazy fluid with WBC count of 23,000, 92% of polymorphic cells and 8% of mononuclear cells. Preliminary cultures from ascitic fluid grew Candida glabrata, and patient was started on caspofungin, and diagnosis of spontaneous fungal peritonitis was made. The patient gradually responded to antifungals. DISCUSSION: Cardiac cirrhosis is defined by signs and symptoms of chronic liver disease along with history of heart failure. Ascites due to heart failure is considered low risk for infections because of the high protein content in the ascitic fluid. Ascitic fluid retrieved by diagnostic paracentesis should be analyzed for lactate dehydrogenase, cytology, total cell count and differential, total protein, albumin, bacterial and fungal culture sensitivities. Along with bacterial gram stain and culture sensitivity, fungal stain and culture sensitivities are necessary due to an increasing prevalence of SFP in patients with cirrhosis. Common species causing SFP is Candida albicans, and other causative fungal agents being Candida glabrata, Candida krusei. Risk factors for SFP include elevated Child-Pugh and MELD scores, use of prophylactic antibiotics for SBP, low ascitic fluid protein (< 1 g/dL), hepatorenal syndrome. Treatment with echinocandins is recommended as soon as the diagnosis is made.