Acute immunoallergic hepatitis presents as acute liver injury, often accompanied by nonspecific findings of fever, rash, and abdominal pain, and is often induced by 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 a 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 allopurinol-induced liver injury. The patient’s liver injury and skin reaction improved with the administration of IV methylprednisolone, followed by a course of oral prednisone. Our case prompts clinicians to prescribe allopurinol with caution in certain high-risk populations and emphasizes the importance of administering cor-ticosteroids early in such a presentation to avoid long-term liver damage.