An otherwise relatively healthy 64-year-old man is found to have small esophageal varices and portal hypertensive gastropathy on an upper gastrointestinal endoscopy performed for persistent dyspepsia. He has a past history of hypertension and asthma. He has no history of alcohol abuse or known liver diseases. He had a full serological work up for liver disease with negative viral, metabolic, and genetic markers. An abdominal ultrasound showed a normal sized nodular liver with collateral circulation but without splenomegaly. He underwent an MRI that did not reveal any liver lesions and confirmed signs consistent with portal hypertension. His serum liver tests revealed an AST of 32 U/L, ALT 43 U/L, INR 1.0, Albumin 42 g/L, ALP 67 U/L, GGT 53 U/L, Bilirubin 1.1 mg/dl [19 mmol/L], Hemoglobin 14 g/L, leukocyte count of 4,300 and platelet count 240,000. On further questioning he states that he has been working at a facility that produces plastics for over 20 years.