History A 63-year-old man presents to his general practitioner (GP) complaining that over the past 3 months he has developed severe generalized itching. This is particularly severe after a hot bath. He has also noticed frequent headaches, dizziness and tinnitus. He has been hypertensive for 10 years. He smokes 35 cigarettes a day and drinks about 25 units of alcohol per week. He takes bendroflumethiazide for his hypertension. Examination His face looks plethoric. He has no rash.

There are no signs of chronic liver disease and no lymphadenopathy. His pulse is 84/min regular and blood pressure 162/104 mmHg. Examination of his heart and respiratory system is normal. In his abdomen the only abnormality is that his spleen is palpable 4 cm below the left costal margin. Neurological examination is normal. What is the likely diagnosis? *This case is from Docplexus editorial team for educative…