Fluctuating Kayser-Fleischer-like rings in a jaundiced patient

An alcoholic patient had cirrhosis and pigmented corneal rings similar to Kayser-Fleischer rings. A slitlamp examination by two ophthalmologists, independently, showed bilateral and circumferential rings. Patients with altered copper metabolism in liver disease other than Wilson's disease have been described to have pigmented corneal rings seen only on slitlamp examination. The results of our patient's copper metabolism studies disclosed that the intensity of the rings correlated directly with the serum bilirubin concentrations. Thus, patients with severe cholestasis may be initially seen with Kayser-Fleischer-like rings that should be evaluated further with copper metabolism studies.