Clinical presentation ranges from asymptomatic to severe liver failure with jaundice, ascites, GI bleeding, and encephalopathy. Typically anorexia, nausea, vomiting, fever, jaundice, tender hepatomegaly. Occasional cholestatic picture mimicking biliary obstruction. Aspartate aminotransferase (AST) usually <400 U/L and more than twofold higher than alanine aminotransferase (ALT). Bilirubin and WBC may be elevated. Diagnosis defined by liver biopsy findings: hepatocyte swelling, alcoholic hyaline (Mallory-Denk bodies), infiltration of PMNs, necrosis of hepatocytes, pericentral venular fibrosis.