Primary intestinal lymphangiectasia (PIL) is a protein-losing enteropathy 
characterized by tortuous and dilated lymph channels of the small bowel. The 
main symptoms are bilateral lower limb edema, serosal effusions, and vitamin D 
malabsorption resulting in osteoporosis. We report here a case of long-lasting 
misdiagnosed PIL with a peculiar liver picture, characterized by a very high 
stiffness value at transient elastography, which decreased with clinical 
improvement. The complex interplay between lymphatic and hepatic circulatory 
system is discussed.