A 58-year-old man presented with jaundice 6 months after aortic valve replacement. Although non-A, non-B hepatitis was initially suspected, the final diagnosis of phenprocoumon (Marcoumar)-induced hepatitis progressing to cirrhosis was based on recurrence of jaundice after re-exposure to the drug, improvement after withdrawal and centrilobular necrosis with eosinophilic infiltration in the liver biopsy. Antibodies to hepatitis C virus were absent. The aortic valve was replaced by a bioprosthesis to eliminate the need for life-long anticoagulation.