Giant cell hepatitis is a rare disorder after the newborn period. Drugs, autoimmunity, and viruses (lately, paramyxovirus infection) have been implicated in its etiology. Without treatment, liver dysfunction is progressive and fatal. Immunosuppression with steroids and azathioprine has been demonstrated to sustain improvement in the disease. In this report, a one-year-old boy who has giant cell hepatitis with Coombs' positive hemolytic anemia and anti-smooth muscle antibodies is presented, and the course of the disease and the patient's response to treatment with steroid and azathioprine is reviewed.