The case is that of a 70‐year‐old Japanese male who had peliosis hepatis with disseminated peliotic lesions in various organs. The initial sign was spontaneous pneumothorax followed by pulmonary hemorrhage. There was no history of anabolic steroid ingestion and his history of pulmonary tuberculosis revealed no pathological changes. Autopsy findings suggested that dilatation of sinusoids with slow progressive injury of sinusoidal endothelium and hepatocytes due to unknown local and general etiologic factors may be an initial mechanism in the development of peliosis hepa