A 40-year-old male smoker of 40 cigarettes/day and drinker of > 50 g alcohol/day, without known liver disease, who comes to the emergency department of our hospital for melenas and vomiting".
Physical examination revealed poor nutritional status, stigmata of chronic liver disease, hepatomegaly of 2 cm, bimale edema and presence of grade 2-3 ascites.
Analytical analysis showed normocytic and normochromic (Hb: 9 g/dl; Hct: 26.6%; VCM: 75 ALT U.m. with 166 U/albumin transaminal: 145 albumin).
Viral serology and other etiologic study of liver disease were negative.
Abdominal ultrasound showed cirrhosis and portal hypertension with moderate ascites.
Urgent gastroscopy was performed with the following findings: moderate esophageal varices occupying less than a third of the esophageal lumen, without warning signs and hypertensive gastropathy.
Two days after admission the patient had fever and abdominal discomfort, so a diagnostic paracentesis was performed, with the following result: leukocytes: 3,500/mm3 (2,975 GDH: Streptococcus pneumoniae/dl; total proteins: 150 mg:
Chest X-ray was normal and blood cultures were negative.
