[Acute

Hemochromatosis (HC) is a disorder of iron metabolism characterized by excessive iron deposition in the body due to genetic mutations or secondary factors, leading to organ damage and dysfunction, particularly in the liver, heart, and pancreas. This disease is relatively rare in China, and cases of hemochromatosis occurring on the basis of post-hepatitis B‑related cirrhosis and subsequently inducing liver failure are even rarer. In October 2022, Guangdong Provincial Hospital of Traditional Chinese Medicine Hainan Hospital admitted a middle‑aged male patient with post-hepatitis B cirrhosis complicated by hemochromatosis, who subsequently developed acute-on-chronic liver failure (ACLF). The patient experienced a sudden and severe deterioration in liver function on the background of long-standing hepatitis B-related cirrhosis, meeting the diagnostic criteria for ACLF. Notably, liver failure occurred despite effective suppression of hepatitis B virus DNA replication, suggesting that non-viral factors contributed to the pathogenesis of liver failure. The diagnosis of hepatic hemochromatosis was ultimately confirmed by liver biopsy. Based on this case and a review of the literature, we propose that in patients with chronic liver disease, especially those presenting with unexplained acute deterioration of liver function or markedly elevated serum ferritin levels, hemochromatosis should be included in the routine differential diagnosis.