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October 1990

A Yellow-Green Posterior Limbal Ring in a Patient Who Does Not Have Wilson's Disease

Author Affiliations

Chicago, Ill

Arch Ophthalmol. 1990;108(10):1385. doi:10.1001/archopht.1990.01070120031014

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

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