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While mild to moderate elevation of liver transaminases is common with anorexia nervosa, acute hepatic injury with severe elevation of transaminases and coagulopathy is rare . We report a 24-year male with anorexia nervosa who was presented with acute liver injury. Alanine transferase and aspartate transferase peaked at 2033 IU/ml and 1410 IU/ml respectively. More common causes of acute liver injury were ruled out. Liver biopsy did not show centrilobular necrosis or congestion which are the hallmarks of ischemic liver injury. The patient has improved on re-institution of proper nutrition. In conclusion, acute liver injury can occasionally be caused by anorexia nervosa. The pathophysiologic mechanism involved, on contrary to what previously reported, is unlikely tissue hypoperfusion.