Infectious mononucleosis is primarily caused by Epstein-Barr virus (EBV) and is a common di-agnosis made in emergency departments worldwide. Subclinical and transient transaminase ele-vations are a well-established sequela of EBV. However, acute cholestatic hepatitis is a rare complication. EBV infection should be considered as part of the differential diagnosis in patients with an obstructive pattern on liver function tests without evidence of biliary obstruction demon-strated on advanced imaging.