GPT and liver failure: He presented with a relapse of hyperpyrexia (42 °C), hypotension, severe leukocytosis with white blood cells (WBC) 38,000, drop in platelet counts (nadir 46,000/mm3), and rapidly ensuing renal failure with creatinine nadir of 4.4 mg/dL and liver failure with alanine aminotransferase (ALT) nadir of 456 U/L.