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Eosinophilic hepatitis is a rare manifestation of hypereosinophilic syndrome (HES), typically requiring exclusion of infectious, drug-induced, autoimmune and neoplastic causes. We report the case of a 54-year-old woman who developed recurrent episodes of acute cholestatic hepatitis with severe peripheral eosinophilia. Despite corticosteroid responsiveness, the patient experienced relapses and intolerance to azathioprine. Introduction of mepolizumab, an anti-IL-5 monoclonal antibody, led to sustained clinical remission, normalisation of eosinophil counts and marked histological improvement, enabling steroid discontinuation. This case underscores the importance of considering HES in the differential diagnosis of eosinophilic liver infiltration and the potential role of mepolizumab as a safe and effective steroid-sparing agent in eosinophilic hepatitis.