Clinical presentation

The patient presented with a 5-week history of abdominal swelling and malaise. She had no medical history apart from a mastectomy for breast cancer 21 years earlier. She consumed 6 units of alcohol per week. Physical examination revealed moderate ascites. Laboratory values were: bilirubin 49 (0–17) μmol/l; aspartate aminotransferase 80 (<35) U/l; alanine aminotransferase 190 (<35) U/l; γ-glutamyltranferase 252 (<58) U/l; alkaline phosphatase 386 (42–121), prothrombin time (PT) 17.9 s/ international normalised ratio (INR) 1.45, serum albumin 30 mg/l and platelet count 95×10⁹/litre. The ascitic fluid cytology was benign. A viral, autoimmune …