The Varicella-Zoster Virus (VZV) is a Herpes Simplex Virus that causes two separate clinical morphologies based on primary versus secondary activation. Primary varicella, chicken pox, presents during childhood as a benign and self-limited pruritic, vesiculopapular rash. Consequently, VZV establishes permanent latency in dorsal root ganglia after initial infection, and can reactivate in older, immunocompromised patients as Herpes Zoster, a localized painful cutaneous eruption distributed in a dermatomal spread. Sequela of herpes zoster include, but are not limited to, pneumonia, post herpetic neuralgia, encephalitis, cutaneous complications, and rarely, hepatitis. Here, we report a case of a 77 year old woman complaining of chest pain, found to have elevated transaminases with subsequent outbreak of a characteristic herpetic rash distributed in the T5-T7 dermatome, indicative of VZV induced hepatitis. The patient is a 77 year old female with a history of Hypertension and Hyperlipidemia presenting with right sided chest and back pain, initially worked up as acute coronary syndrome with a positive stress stress and subsequent negative cardiac catheterization. Two days after presentation, she was noted to have elevated Liver function tests up to the 400s. Hepatitis serologies were negative. Four days after presentation, a characteristic dermatomal rash was observed on the right side of the chest wall and in the absence of other evident causes of raised Liver function tests, a diagnosis of VZV induced hepatitis was made. She was treated with Valacyclovir and Liver function tests started to downtrend. VZV is a rare cause of hepatitis, and although uncommon, is potentially fatal. Typical and more frequently, varicella presents with eruptions of cutaneous lesions, abdominal or back pain, and fever. Literature shows the classic herpetic rash may proceed, be parallel with, or appear delayed in relation to abdominal complaints or elevation in liver function tests. It is documented that patients with severe VZV may even lack cutaneous eruption altogether, progressing to developing fulminant liver failure and consequently coagulopathies and shock. Based on severity, VZV hepatitis can advance to fibrosis and eventually cirrhosis, and thus, symptoms of abdominal pain with persistently elevated liver enzymes warrant a workup suggestive of VZV by the presence of varicella DNA in serum, tissue samples or positive viral cultures of skin cultures when lesions are present.