ABSTRACT
Introduction: Wilson's disease (WD) is a disorder of coppermetabolism leading to the accumulation of this metal indifferent organs. Hepatic manifestations tend to occur in thefirst decade and neurological symptoms in the third decade.Neurological manifestations are said to worsen with chelationtherapy.Case report: In our patient however the initial manifestationwas head tremor at the age of 43 years which improved withtreatment. The patient for some reason stopped the therapy for8 years after which he decided to resume it only to precipitatethe liver cirrhosis clinically –something that has not beenreported earlier. The diagnosis was missed initially. Howevertreatment produced good results.Conclusion: The case also serves as a reminder not to dismissthis disease as a rare theoretical possibility but to suspect itin a case of liver cirrhosis of unknown etiology or when thepatient presents with an obscure isolated neurological signsuch as tremor. Delayed recognition of the disease or stoppingtherapy can lead to a progression of the disease. The patienthad many unusual features which are being reported for futurereference by researchers and practioners