A 32-year-old woman was found to have chronic active hepatitis and cirrhosis after exploratory celiotomy resulted in hepatic decompensation. Subsequent investigation confirmed the diagnosis of Wilson's disease. This case demonstrates that Wilson's disease may manifest itself as chronic active hepatitis as late as the fourth decade of life without neurologic symptoms or findings. Wilson's disease should be actively considered in patients with chronic active hepatitis or cirrhosis, even in older age groups and despite the absence of central nervous system manifestations.