A study has been made of 7 alcoholic and 2 non-alcoholic patients with symptomatic porphyria. Siderosis (mild or absent in most cases), focal fatty change and lipofuscin pigmentation were noted on light microscopy while ultrastructural study revealed that focal cellular lysis was unexpectedly common. Unidentified cytoplasmic inclusions (possibly porphyrins) were present in 3 cases. It was concluded that increased synthesis and storage of porphyrins in the liver could lead to some cytoplasmic damage, but that alcoholic excess probably accounts for the majority of the hepatocellular abnormalities.S. Afr. Med. J., 48, 1803 (1974