In patients with pre-existing liver disease, acute-on-chronic liver failure (ACLF) may occur and includes criteria of multi-organ failure precipitated by an acute insult [15]. In our patient's case, while liver enzymes were markedly elevated following ceftriaxone administration (ALT 415 IU/L and AST 452 IU/L), these values alone do not confirm liver failure. Here, GPT is linked to acute-on-chronic liver failure.