Athlete's hepatitis is an uncommon clinical condition characterized by a significant ischemic insult to the liver. The most likely pathogenesis is decreased blood supply to the liver resulting in significant hypoxic hepatocyte injury. We report a case of a 48-year-old healthy young male who presented with athlete's hepatitis confirmed by liver biopsy after a 14-mile marathon run. To our knowledge, this is the second case of athlete's ischemic hepatitis reported in the literature. It is a diagnosis worth considering in patients involved in extreme exercise programs.