The case history is presented of a woman who developed serious liver injury while using ranitidine (Zantac). Complete clinical recovery and normalization of liver function tests were seen after discontinuation of the drug. Since 1983 five other similar cases have been reported to the Netherlands Centre for Monitoring of Adverse Reactions to Drugs. No viral cause was found in these cases and three of the six patients used no other medication that may cause liver injury, so that a causal relationship with the use of ranitidine may be assumed. The clinical symptoms of the cases and the available literature suggest metabolic idiosyncrasy as the mechanism, most likely through an immunoallergic reaction.