Gemcitabine is widely used in oncology practice. There are rare reports of gemcitabine causing hepatotoxicity with all affected patients dying from acute liver failure. We describe a patient with stage 4 lymphoma who presented with an acute deterioration in liver function tests and hepatic encephalopathy not directly attributed to his disease. He had been taking gemcitabine for 5 months before admission. His clinical and biochemical problems resolved after discontinuing the drug. This is the first case described of a severe hepatotoxic reaction associated with gemcitabine that was followed by a complete recovery.