The ophthalmologist is often asked to help rule out Wilson's disease in a young patient with liver function abnormalities. We report a case of a patient with corneal findings similar to a Kayser-Fleischer ring but with a highnormal ceruloplasmin level, chronic active hepatitis, and hemolysis.
Report of a Case.
—A 35-year-old black man with a history of intravenous drug and alcohol abuse presented with a 2-month history of pruritus, night sweats, and a 9-kg weight loss. The physical examination was remarkable for jaundice, scleral icterus, and mild hepatomegaly.Peak laboratory values at admission included a total bilirubin of 964.4 μmol/L (normal, 3.4 to 17.1 μmol/L), with a direct bilirubin of 613.9 μmol/L (normal, 0.0 to 8.6 μmol/L). The serum ceruloplasmin level was 600 μmol/L (normal, 200 to 600 μmol/L). Serologic test results were negative for hepatitis A and B, human immunodeficiency virus, mitochondrial antibody, and heterophil agglutinins. A liver