A 17-year-old woman with phenytoin-induced hepatotoxicity was compared with 23 other cases from the literature. Hepatic injury caused by phenytoin is rare but important because of its significant morbidity and mortality. A typical multisystem clinical pattern precedes the manifestations of hepatic dysfunction. Pathologic findings indicate a mixed hepatocellular damage of cholestasis and necrosis. Pathogenic mechanisms are unexplained, but a delayed hypersensitivity reaction appears likely.