A 42-year-old woman visited the doctor complaining of excessive thirst and an overall feeling unwell. She had no prior medical conditions, had not traveled abroad, used intravenous drugs, or received blood transfusions. The only medication she was taking was a birth control pill (Diane-35 ED) containing ethinyl estradiol and cyproterone acetate for over three years. She consumed alcohol moderately (less than 20 g/day) and was obese. Her physical examination did not reveal any signs of chronic liver disease. Her fasting blood sugar level was very high at 340 mg/dL (normal range: < 126 mg/dL). Liver function tests showed mild abnormalities, including elevated ALT, AST, GG, and ALP levels. Serum albumin, bilirubin, complete blood count, and prothrombin time were all within normal ranges. An abdominal ultrasound showed increased echogenicity of the liver. Fasting lipid levels at diagnosis revealed elevated total cholesterol and triglycerides. She was started on metformin and gliclazide to manage her blood sugar levels, which proved effective. Four weeks later, the patient developed a severely itchy skin rash with red patches on her chest, abdomen, back, and legs. This rash resolved after four days of treatment with an antihistamine (fexofenadine). During a follow-up appointment two weeks later (six weeks after starting treatment), her liver tests were still abnormal, with increased bilirubin levels and significantly elevated ALT, AST, GGT, and ALP. Metformin was suspected as the cause and was discontinued. Three days later, she became jaundiced, and her liver enzymes continued to rise. She also had peripheral eosinophilia and an elevated prothrombin time, leading to her hospitalization due to concerns about acute liver failure. On examination, she had jaundice and an enlarged liver but no other signs of liver disease. Tests for autoimmune and viral hepatitis were negative, and her alpha-1-antitrypsin levels were normal. She was immune to hepatitis B and negative for hepatitis A and C. Ferritin and ceruloplasmin levels were initially elevated but normalized once her acute illness resolved. Her serum albumin, globulin, and immunoglobulin G (IgG) levels were all within normal ranges.