Introduction: Hepatitis is a rare manifestation of herpes simplex virus (HSV) infection, usually affecting immunosuppressed patients and females in the third trimester of pregnancy, often leading to fulminant hepatitis, acute liver failure, liver transplantation, and/or death. We present a rare case of herpetic hepatitis in an immunocompetent male. Case Report: A 26-year-old incarcerated male was brought to the hospital with nausea, vomiting, and altered mental status. The patient was awake on presentation, but did not respond to questions. His vital signs were stable. On physical examination, the patient did not follow commands, had scleral icterus, his abdomen was non-tender to palpation, and no organomegaly was appreciated; no skin, oral, or genital lesions were present, deep tendon reflexes were equal and symmetric. His labs revealed an AST of 247 u/l, ALT of 422 u/l, total bilirubin 6.6 mg/dL, direct bilirubin 2.8 mg/dL, ammonia level 59.3 umol/L (reference range 11-32 umol/L). He tested negative for HIV, hepatitis A, B, and C. Autoimmune studies and viral studies were ordered. Ultrasound of the abdomen showed unremarkable liver and pancreas with no biliary duct dilatation; magnetic resonance imaging (MRI) of the brain was normal and an electroencephalogram (EEG) revealed diffuse slowing consistent with mild encephalopathy. Over the next few days, although the patient’s liver enzymes continued to rise (ALT 1191 u/l, AST 416 u/l), his ammonia level normalized and his altered behavior had resolved. Autoimmune studies were negative, but his viral studies revealed markedly elevated IgM and IgG levels for HSV 1 and 2. Discussion: Hepatitis is an uncommon manifestation of HSV, usually rare in immunocompetent adults. When hepatitis does occur due to HSV, it is frequently fulminant. HSV Hepatitis is often overlooked in the differential diagnosis of severe hepatitis due to lack of specific symptoms or signs such as skin, mouth, and/or genital lesions, which are present in 57% of patients with HSV hepatitis. Further diagnostic challenges result from lack of rapid diagnostic modalities for HSV. The above factors lead to dangerous delays in early antiviral therapy, which is key to survival. HSV hepatitis carries high mortality (>80%), but is one of the few treatable causes of acute liver failure, reemphasizing the need for early diagnosis and treatment with acyclovir or vidarabine. This case highlights the rare manifestation of HSV infection as fulminant hepatitis in an immunocompetent adult. In light of his rapidly rising liver enzymes with no obvious etiology, a wide range of differentials were investigated with the most unlikely etiology emerging as the culprit.