41-year-old male, with a personal history of treated pulmonary tuberculosis, with no other personal history of interest except moderate alcoholic drinker. He was referred to our centre due to a gradual increase in abdominal circumference since the previous month, together with oedema in the lower limbs. No other accompanying symptoms. Laboratory tests showed altered coagulation (prothrombin time 43%), creatinine 0.58 mg/dl, cholesterol 77 mg/dl, albumin 1,610 mg/dl. An abdominal ultrasound confirmed the diagnosis of hepatic steatosis and portal hypertension, together with collateral circulation and ascites, all probably related to excessive consumption of alcoholic beverages (virological study for hepatitis was negative). Gastroscopy revealed grade III oesophageal varices, a small hiatus hernia and gastropathy secondary to portal hypertension.
Given the clinical and analytical findings, protein-losing disease was suspected, so A1AT clearance was performed and was 45 ml/day (> 24 ml/day) [A1AT in blood: 190 mg/dl; A1AT in stool: 0.38 mg/g; stool weight in 24h: 225 g], and he was diagnosed with the same, in relation to his portal hypertension. He was treated with alcohol abstinence, oral hyperproteic nutritional supplements and diuretics, improving clinically and analytically, and was discharged for outpatient follow-up at his reference centre.