Acute immunoallergic hepatitis presents as acute liver injury, often accompanied by nonspecific findings of fever, rash, and abdominal pain, and is often induced by a drug ingestion. Allopurinol has been implicated in multiple cases of acute immunoallergic hepatitis. We present the case of a young East Asian male with gout who experienced acute immunoallergic hepatitis, complicated by DRESS syndrome with severe cutaneous reaction, as a result of allopurinol intake. The patient was positive for the HLA B58*01 gene, a significant risk factor for developing an allopurinol-induced liver injury. The patient’s liver injury and skin reaction improved with administration of IV methylprednisolone, then a course of oral prednisone. Our case prompts clinicians to prescribe allopurinol with caution in certain high-risk populations, and it emphasizes the importance of administering corticosteroids early in such a presentation to avoid long-term liver damage.