INTRODUCTION: SARS-CoV-2, is responsible for COVID-19, disease severity of COVID-19 has varied from mild to severe with patients experiencing respiratory and/or multisystem organ dysfunction. Several studies have documented the presence of elevated liver enzymes at time of presentation or during the course of hospitalization for COVID-19. Additionally, there is 1 case report of a patient presenting with acute hepatitis. We present the case of a 44 year old female with acute hepatitis secondary to SARS-CoV-2 infection. CASE DESCRIPTION/METHODS: Forty-four yo f PMHx Hashimoto's thyroiditis, hypertension who presented urgent care 5 days prior with symptoms of cough, body aches, fever, chills, nausea and vomiting, and was found to test positive for SARS-CoV-2. Her initial chest x-ray displayed patchy bilateral interstitial and alveolar airspace opacities. Significant labs at time of admission included ALT/AST 588/321 IU/L (n < 52/32 respectively), normal TBili and Alk Phos, Ferritin 712 ng/mL, CRP 6.3 mg/dL, LDH 284 IU/L, WBC 3.4 K/uL, absolute lymphocytes 0.60, and D-dimer 1.27 ug/mL. The patient had no prior history of hepatitis, blood transfusions, recent travel, diarrhea, alcohol abuse, IV drug use or family history of liver disease. Her ALT/AST peaked at 1,404/360 on day 5 of hospitalization. Work-up for the elevated transaminases included a viral hepatitis panel, abdominal ultrasound with and without Doppler, ANA, autoimmune liver panel, all of which resulted as negative. Liver biopsy was obtained for definitive diagnosis. Final pathology report is notable for, “morphologic findings demonstrating mild lobular inflammation,” with a negative CMV immunostaining. DISCUSSION: A study recently submitted to the Journal of Hepatology evaluated the clinical characteristics of COVID-19 in 417 patients. Of these patients, 318 exhibited elevations in liver functions test, 90 of whom had liver injury during the hospitalization. It was noted that utilization of certain antiviral medications contributed significantly to the detrimental effects. In the short span of a few months, several cases of COVID-19 induced liver injuries have been seen across the world. This is has shed light on identifying at risk populations. Further research is needed in determining the causes of liver injury in COVID 19 patients.Figure 1.: Liver biopsy demonstrating normal portal tracts and mild lobular inflammation of the without steatosis, granuloma or necrosis.Table 1.: On admission pt had elevated ALT/AST, initially ruled out acute hepatitis, portal/hepatic vein thrombosis, ANA negative. Pt was already getting steroids for COVID-19. LFTs peaked on day 5 of admission and trended downwards and pt was discharged home. As we can see above 7 days after discharge her LFTs trended downwards.