Toxic hepatitis or drug-induced liver injury encompasses a spectrum of clinical disease ranging from mild biochemical abnormalities to acute liver failure. The advantages of along half-life, wide spectrum, high tissue penetration rate, and a good safety profile, make ceftriaxone, a third-generation cephalosporin, a frequent choice in the treatment of childhood infections. Previous studies have reported a few cases of high aspartate aminotransferase and alanine aminotransferase levels, along with three cases of hepatitis caused by ceftriaxone. Here, we report a case of drug-induced toxic hepatitis in a patient who was treated with ceftriaxone for acute tonsillitis. (C) 2009 The WJG Press and Baishideng. All rights reserved.