Wilson's disease or chronic copper poisoning?

The case history is given of a child who presented at 14 months with ascites and was found to have severe micronodular cirrhosis with biochemical evidence of Wilson9s disease, but in view of the severity of the pathology and early age of presentation, the possibility of chronic copper poisoning was investigated. It was found that the child9s drinking water was obtained from a bore via new copper pipes. The bore water had a pH of 4·4 and after passage through copper pipes had a very high copper level of 675 μg/100 ml. He subsequently died from liver failure and at necropsy very high copper levels were found in his liver. The final diagnosis remains uncertain.