A 46-years old man with a recent onset of painful hepatomegaly and abdominal swelling was referred to the emergency department and hospitalized in the internal medicine ward for a diagnostic hepatological work-up. He had no clinically significant previous medical history, except for a mild long-standing polycitemia. When admitted to hospital, he was febrile but hemodynamically stable (blood pressure 100/60 mmHg, pulse rate 90/min) and had a satisfactory blood oxygen saturation levels in room air. At clinical examination, he was slightly sub-icteric; a palpable but tender hepatomegaly together with a significant abdominal effusion and a mild leg swelling were noticed. In order to evaluate different possible causes of liver disease, alcoholic, viral, autoimmune, metabolic and congenital etiologies were excluded, mainly by biochemical tests.