Extrahepatic causes of transaminase elevation are often overlooked when evaluating patients with chronic liver disease. A 54-year-old woman was referred for the management of chronic hepatitis B (HBV). Serologic testing showed a pattern of chronic hepatitis B infection with mild transaminase elevation. Further diagnostic testing suggested a pattern of quiescent HBV disease. Additional testing revealed no other explanation of the abnormal transaminase level and liver biopsy showed no significant pathologic change. She subsequently returned with malabsorption complaints and tested positive for celiac disease antibodies. Duodenal biopsies confirmed the presence of villous atrophy. The celiac disease was therefore the cause of the elevated transaminases concealed by the finding of a positive HBsAg. Elevated liver enzymes may be the only disease in the standard evaluation of patients with chronic liver disease as well as asymptomatic elevated liver enzymes.