Epstein-Barr virus (EBV) can cause symptomatic hepatic involvement, especially in immunocompromised individuals. Hepatic involvement is usually characterized by mild liver enzyme abnormalities, abdominal discomfort, and even clinical jaundice reported in the literature that self-resolves with no need for specific treatment. We present an unusual case of an immunocompetent young male who developed fulminant hepatitis induced by EBV with fatal course despite administration of antiviral drug therapy and steroids. Etiology was established with positive serology compatible with acute EBV infection with an elevated titer of immunoglobulin (Ig) M antibody against EBV capsid Ag, negative EBV capsid IgG antibody, and negative EBV nuclear antibody. A discussion based on the review of the literature is presented. © 2009 Lippincott Williams & Wilkins, Inc.