Four patients who were referred to the Liver Failure Unit with an initial diagnosis of fulminant hepatic failure were found to have severe bacterial infection from a primary septic focus as the cause of their illness. Clinical and biochemical characteristics were not helpful in differentiating these patients from those with hepatic failure from other causes, and only a high degree of suspicion will prevent delay in the diagnosis of underlying sepsis and initiation of appropriate treatment. The possible mechanisms responsible for this uncommon association are discussed.