Figure 1

Serial serum alanine aminotransferase and total bilirubin levels. The patient's serum ALT and total bilirubin initially improved with a short course of oral corticosteroids. However, 3 weeks after discontinuing the prednisone, his serum ALT markedly increased and he was rehospitalized. Despite high doses of corticosteroids, he developed progressive mental status changes and died 105 days after initial presentation with sepsis and liver failure.