We present a case of a 17-year-old man with first-episode schizophrenia who developed olanzapine-induced hepatitis, cholestasis, and splenomegaly, all of which were reversed after ceasing olanzapine. Clinicians prescribing olanzapine should be aware of this possible hepatotoxicity. Patient education, vigilance from clinicians, and careful clinical examination can help detect this complication early.