Alcoholic foamy degeneration is a recently recognized type of alcohol related liver disease. We report 3 cases occurring in men aged 40, 51 and 38 years. All 3 patients had marked elevation of serum aminotransferases which decreased rapidly after withdrawal of alcohol intake. In each case, the diagnosis of alcoholic foamy degeneration was made on microscopic examination of a liver specimen. The lesion is similar to that found in other diseases in which microvesicular steatosis is a main finding, such as acute fatty liver of pregnancy and Reye's syndrome. This condition, when isolated, is a rare form of alcoholic liver disease. A milder form probably exists, more commonly associated with other alcoholic liver injuries. The diagnosis of alcoholic foamy degeneration must be suspected when marked elevation of serum aminotransferases is observed in alcoholic patients, and it must be confirmed by microscopic examination.