A 63-year-old man presented to us with fever and mild abdominal pain. He had a previous history of chronic active hepatitis B in treatment with entecavir and tenofovir. Clinical and laboratory examinations on blood and ascitic fluid were suggestive of spontaneous bacterial peritonitis. Empirical therapy with piperacillin tazobactam and a prophylactic dose of enoxaparin were administered. After three days from admission he presented an acute abdomen and a platelet count drop of more than 50% of baseline (nadir 60,000/mm3). Nasogastric aspiration, bowel rest and parenteral nutrition commenced