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A 29-year-old Chinese man with a 6-year history of UC (Montreal classification E3) had achieved symptom remission 4 years ago after 1 year of treatment with infliximab (5 mg/kg at 0, 2 and 6 weeks, followed by every 8 weeks) combined with azathioprine (50 mg/day). He then self-switched to mesalazine (4 g/day). He returned to our hospital with severe bloody diarrhoea (over 20 bowel movements/day) for 1 week. On admission, he had a mild fever (37.8°C), tachycardia (120 bpm), pallor and pitting oedema in both lower extremities. Laboratory analysis revealed anaemia (7.5 g/dL), hypoalbuminaemia (2.8 g/dL), thrombocytosis (638 k/mm3), leucocytosis (23.71 k/mm3), elevated C reactive protein (112.3 mg/L), elevated erythrocyte sedimentation rate (55 mm/h) and mildly elevated GGT (80 U/L). Viral markers for HIV, HBV and HCV were negative. A colonoscopy revealed severe pancolitis with deep ulcers (figure 1A). Given the consideration of acute severe UC, intravenous methylprednisolone was administered, along with empirical treatment using meropenem, ganciclovir and low-molecular-weight heparin calcium. After 1 week, his bloody diarrhoea ceased, but he developed abdominal distension, ascites, worsening oedema of both lower extremities and a significant rise in GGT (1123 U/L). Paracentesis revealed transudative ascitic fluid (protein 2.1 g/dL). Contrast-enhanced CT showed continuous thickening of the colon, ascites, hepatomegaly with heterogeneous enhancement (figure 1B,C), unclear hepatic veins and narrowing of the inferior vena cava at the hepatic segment (figure 1C). To further determine the cause, an ultrasound-guided liver biopsy was performed.