Mild elevation of aminotransferases is a common feature of dengue virus infection, and severe acute liver injury has been described. The aim of this retrospective study was to assess relationships between antipyretic drugs and chronic alcohol use and the increase in serum alanine aminotransferase (ALAT) level in patients hospitalized with dengue fever during the 2005-2006 dengue epidemics in French Guiana. In the 162 included patients in this study (99 adults [62%] and 63 children [38%]), 2 analysis were performed comparing (1) 64 adults (65%) with an ALAT value greater than twice the upper limit of the normal value and 35 controls (35%) and (2) 24 children (39%) with an ALAT value greater than twice the upper limit of the normal value and 38 controls (61%). The factors associated with ALAT elevation were: (1) acetaminophen exposure and length of intake in adults and (2) acetaminophen overdose during the hospitalization of children. Another analysis suggested a role for alcohol consumption. Acetaminophen and alcohol consumption should be searched and taken into account in dengue fever.