Hepatocellular presentation occurs only in 25% of cases,[24] with ALT prominently increased by a factor of 5 to 50.[23,26] Despite its relatively high frequency, severe presentation is rare.[24] When it does occur, severe cases present with marked increase in transaminases and total bilirubin.[24,27] Histology usually shows cholestatic patterns of injury or cholestasic hepatitis. This evidence concerns the gene GPT and hepatitis A virus infection.