A 77-year-old male with HBV related cirrhosis, Child-Turcotte-Pugh class C and a model for End-Stage Liver Disease score of 18 was hospitalized due to an alteration of consciousness and fever. A diagnosis of a first episode of stage 2 episodic type C hepatic encephalopathy (HE) precipitated by a urinary tract infection was made. The patient started empirical antibiotic therapy, lactulose per os and enemas with a prompt resolution both of infection and HE.