Eight patients with end-stage renal disease (ESRD) who developed bacterial infection of the perirectal area or perineum are reported. The diagnosis was not always straightforward. Bacteremia was seen in 3 of 8 patients and one of these died. Careful examination of the anus, rectum, and perineum should be mandatory in ESRD patients with undiagnosed fever. Treatment consisted of extensive surgical debridement and drainage along with antimicrobial therapy.