GPT and Hyperbilirubinemia: Following this second discharge, the patient experienced a re-aggravation of AST and ALT to grade 3 (225 U/L and 397 U/L, respectively), grade 3 hyperbilirubinemia (total and direct bilirubin of 3.27 and 1.62 mg/dL) and grade 4 GGT elevation (1883 U/L) (Figure 4).