A patient who presented with severe hepatic Wilson's disease at age 14 responded well to treatment with penicillamine and remained in good health for a further 20 years, although she became somewhat careless about her medication towards the end of this period. Finally she abandoned treatment altogether and died of hepatic failure 2 1/2 years later. Abdominal computed tomography showed that the main structural damage to the liver occurred in this relatively short period of non-compliance after over 20 years of normal health on maintenance penicillamine therapy.