Question: A 19-year-old boy presented to our hospital because of a 6-month history of progressive dyspnea and generalized edema. He developed cough, abdominal fullness, diarrhea, and leg edema 5 years ago. Liver cirrhosis was suspected at that time. However, he seemed to have a poor response to medical treatment. Physical examination showed decreased breathing sounds and rales of bilateral lower chest area, a distended abdomen with multiple purple striae, and edema of bilateral lower legs. Laboratory tests showed a low serum total protein of 3.8 g/dL (normal range, 5.5–8), albumin of 2.0 g/dL (normal range, 3.8–5.4), total calcium 7 mg/dL (normal range, 8.4–10.8), C-reactive protein of 11.02 mg/dL (normal, <0.8).