6-Mercaptopurine (6-MP) is a chemotherapeutic drug that exhibits hepatotoxic effects due to its toxic metabolites. This report describes a case of suspected drug induced liver injury exacerbated by a Sars-Cov-2 infection. A 16-year-old male with VHR B-ALL was admitted for hyperbilirubinemia two months after a 6-MP dosage increase and found to have an active Sars-Cov-2 infection. Liver function improved throughout hospitalization and the patient was discharged on allopurinol. Following liver function after a dosage increase of hepatoxic chemotherapy and in a pediatric oncology patient with an active Sars-Cov-2 infection undergoing treatment is vital due to potential liver impact.