Purpose: Patient is a 56-year-old Caucasian male who is status post liver transplantation on 5/30/06 for chronic hepatitis C, cirrhosis, and concomitant hepatocellular carcinoma. The patient had posttransplant complications including loculated fungal peritonitis with an organized intraabdominal abscess that has required catheter drainage. His fluid grew out Candida tropicalis resistant to voriconazole. Anidulafungin was administered at 200 mg for the first dose and then 100 mg once daily each day thereafter. Two weeks after starting this medication, the bilirubin had climbed to 9.1 from 0.6 with a GGT up from 67 to over 2000. The remainder of the patient's labs remained stable including his CBC, coagulation studies and CHEM 14. Patient's vital signs were within normal limits. The physical exam was only significant for a well healed chevron scar and jaundice. While recent liver biopsy findings were suggestive of large duct obstruction, an MRCP did not show any significant extrahepatic duct dilation and ERCP confirmed this finding. It was felt the cholestatic picture was likely secondary to the anidulfungin and it was discontinued. Within two weeks, the bilirubin fell to 2.8 and the GGT dropped to 228. The anidulafungin was restarted due to the severity of the fungal infection. The bilirubin and the GGT again rose, but the drug was continued for two more weeks until the infection was eradicated. Following discontinuation of the anidulafungin, the patient's labs again returned to normal limits. The patient is now over one year out from his transplantation and 9 months out from his infection and continues to do well. Prior to reporting these events to the maker of the drug, there was no evidence reports of elevated bilirubin associated with anidulafungin. Now it is a box warning. In the case of our patient, we were able to successfully treat the Candida tropicalis while tolerating the elevated GGT and bilirubin in a newly transplanted patient.