Sulfasalazine hepatotoxicity has been poorly documented in the literature. We report a case of a young female with inflammatory bowel disease who developed severe hepatotoxicity as part of a systemic hypersensitivity reaction to sulfasalazine. The clinical, biochemical, and histopathological features resemble those of sulfonamide-induced hepatic injury. Although rare, our case as well as previous reports indicate the serious nature of the illness.