We discussed a middle aged man with heavy alcohol use presenting with jaundice found to have profound liver failure. It is important to note acute liver failure warrants consideration for transplant candidacy urgently. However, previous records revealed this patient had a history of cirrhosis and prior alcoholic hepatitis, this patient likely suffered from acute on chronic liver failure from alcoholic hepatitis. We reviewed the broad differential for jaundice and specifically for conjugated hyperbilirubinemia (attached). Alcoholic hepatitis may manifest as fever, jaundice, hepatomegaly and leukocytosis. Maddrey’s DF score is used to prognosticate. A score >32 warrants consideration of corticosteroids. STOPAH trial shows nonsigifnicant survival advantage at day 28 in patients with prednisolone vs no prednisolone.