INTRODUCTION: A few cases of cocaine induced hepatotoxicity (CIH) have been reported in humans. Most of these cases were associated with chronic use in males, with only one case reported in females. We present a rare case of CIH associated with a binge in a female Hispanic patient with a chronic history of illicit drugs use. CASE DESCRIPTION/METHODS: A 32-year-old Hispanic woman with no known medical history presented to the emergency room (ER) for the evaluation of abdominal pain. Pain was said to have commenced about 10 hours prior, located in the right upper quadrant (RUQ), radiating to the back and epigastric area. Pain was described as sharp and only said to be associated with nausea. She denied the use of any illicit drugs. She was hemodynamically stable and physical examination revealed a woman in moderate painful distress and she was anicteric. Abdomen examination was significant for tenderness to palpation in the RUQ. Initial laboratory investigation was significant for elevated AST- 1236 IU/L (N: 13-39 IU/L), ALT- 955 IU/L (N: 7-52 IU/L), ALP- 127 IU/L (N: 34-104 IU/L), and normal total bilirubin. LDH was also elevated 826 IU/L (N: 140-271 IU/L). An extensive work-up was ordered. Interestingly, urine drug screen returned positive for amphetamine, barbiturates, cocaine and tetrahydrocannabinol. She later admitted using drugs on the day prior to admission. All the other results were not significant. At this point, symptoms had significantly improved with conservative management and she was discharged on the 2nd day of admission. DISCUSSION: The pattern of liver enzymes in our patient appears to be characteristic of what has been described in prior case reports of CIH. Worth mentioning that, in mice models, there appears to be a difference in the manifestation and pattern of injury by gender. In a study conducted by Visalli et al, both male and female mice were exposed to the same amount of cocaine, but male mice had significantly more severe disease. Lopez Patino et al also described similar gender differences in zebrafish. It is entirely unclear why these gender differences exist; however, it has been postulated that there is a possibility that males and females metabolize some of the enzymes differently. Our review showed the potential role of gender in cocaine metabolism. In patients presenting to the ER, a high index of suspicion is required to improve overall patients' outcomes and avoid unnecessary procedures. Lastly, there is a need for continued research in the area of CIH.