Rosuvastatin therapy is associated with mild, asymptomatic and usually transient serum aminotransferase elevations in 1 to 3% of patients, but levels above 3 times the upper limit of normal (ULN) occur no more frequently among rosuvastatin treated [0.2%] as placebo [0.3%] recipients. Serum enzyme elevations are more common with higher doses of rosuvastatin, being 2.2% with 40 mg daily. Most of these elevations are self-limited and do not require dose modification. Rosuvastatin is also associated with frank, clinically apparent hepatic injury but this is rare, occurring in less than 1:10,000 patients. The onset is typically after 2 to 4 months and the pattern of serum enzyme elevations is usually hepatocellular, although cholestatic cases have also been reported. Rash, fever and eosinophilia are uncommon. Several of the statins including rosuvastatin have been linked to hepatitis with autoimmune features including elevated immunoglobulin levels, ANA positivity and a clinical response to corticosteroids. Such features are not, however, invariable (Case 1).