Transplant-Free Recovery in Wilson Disease-Associated Acute Liver Failure.

Wilson disease-associated acute liver failure carries high mortality without urgent liver transplantation. Diagnosis is challenging when classical signs like Kayser-Fleischer rings are absent. We report a 28-year-old woman presenting with Wilson disease-associated acute liver failure characterized by Coombs-negative hemolytic anemia, profound hyperbilirubinemia, low alkaline phosphatase, and a New Wilson Index score of 14. Despite predicting poor transplant-free survival, she achieved complete clinical and biochemical recovery following aggressive copper-removal therapy using chelation, zinc, therapeutic plasma exchange, and continuous renal replacement therapy. This case demonstrates that early combined extracorporeal liver support can successfully bridge patients to recovery, potentially obviating liver transplantation.