Referral was then pursued following a 2-wk period of progressive worsening of pleural effusion, onset of chronic vomiting and lethargy, appearance of a marked inflammatory leukogram, and marked worsening of liver enzyme activities (ALT = 767 IU/L; ALP = 1,960 IU/L; GGT = 63 IU/L, RI: 0–25 IU/L). The gene discussed is GPT; the disease is Pleural effusion.