Background : Drug-induced liver injury is the most common cause of acute liver failure in western countries by prescription drugs and herbal medications. Liver injury due to azithromycin has rarely been reported.

Methods : This is a brief report of a patient administered azithromycin and who developed acute liver failure leading to liver transplantation.

Results : We report the case of a 68-year-old woman who developed jaundice 1 week after she started taking a azithromycin. On the third day of hospitalization, her hepatic function rapidly deteriorated and level of consciousness decreased to drowsiness. The Model for End-Stage Liver Disease score was confirmed to be 33, and liver transplantation was considered. On the eighth day of hospitalization, she underwent emergency living donor liver transplantation, receiving a right lobe liver graft from a 35-year-old male donor, the patient’s son. Currently, she is alive with good liver function after 25 months of transplant.

Conclusions : This case suggests that azithromycin my cause rare hepatitis with liver failure. Therefore, at the beginning of the azithromycin treatment, patients should visit the hospital immediately if symptoms such as jaundice and abdominal pain are experienced.